Academic literature on the topic 'Biopsychosocial model of chronic pain'
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Journal articles on the topic "Biopsychosocial model of chronic pain"
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Miaskowski, Christine, Fiona Blyth, Francesca Nicosia, Mary Haan, Frances Keefe, Alexander Smith, and Christine Ritchie. "A Biopsychosocial Model of Chronic Pain for Older Adults." Pain Medicine 21, no. 9 (December 17, 2019): 1793–805. http://dx.doi.org/10.1093/pm/pnz329.
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Abstract Population Comprehensive evaluation of chronic pain in older adults is multifaceted. Objective and Methods Research on chronic pain in older adults needs to be guided by sound conceptual models. The purpose of this paper is to describe an adaptation of the Biopsychosocial Model (BPS) of Chronic Pain for older adults. The extant literature was reviewed, and selected research findings that provide the empiric foundation for this adaptation of the BPS model of chronic pain are summarized. The paper concludes with a discussion of specific recommendations for how this adapted model can be used to guide future research. Conclusions This adaptation of the BPS model of chronic pain for older adults provides a comprehensive framework to guide future research in this vulnerable population.
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Bevers, Kelley, Lynette Watts, Nancy D. Kishino, and Robert J. Gatchel. "The Biopsychosocial Model of the Assessment, Prevention, and Treatment of Chronic Pain." US Neurology 12, no. 02 (2016): 98. http://dx.doi.org/10.17925/usn.2016.12.02.98.
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The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the modern biopsychosocial model. Additionally, functional restoration and other early interdisciplinary intervention programs will be highlighted for their importance and effectiveness in chronic pain management, assessment, and prevention.
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Moseley, Lorimer. "Chronic Pain-related Disability: Current Scientific Rationale and Recommendations for Practice." Australian Journal of Rehabilitation Counselling 5, no. 1 (1999): 9–22. http://dx.doi.org/10.1017/s1323892200001186.
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The present paper concerns the prevention and management of disability due to chronic pain. The problem of disabling chronic pain is presented and the impact on the community is highlighted. The scientific rationale for current approaches to management is discussed and the available empirical evidence reviewed. In particular, the present paper advocates application of the biopsychosocial model for the prevention and management of chronic pain-related disability. As such, the components of the biopsychosocial model are reviewed and recommendations for rehabilitation counselling practice are presented.
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van Dijk, Han, Albère J. A. Köke, Stefan Elbers, Jurgen Mollema, Rob J. E. M. Smeets, and Harriët Wittink. "Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators—A Scoping Review." International Journal of Environmental Research and Public Health 20, no. 2 (January 16, 2023): 1634. http://dx.doi.org/10.3390/ijerph20021634.
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The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs.
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Dwyer, Christopher P. "Factors Influencing the Application of a Biopsychosocial Perspective in Clinical Judgement of Chronic Pain: Interactive Management with Medical Students." september 2017 6, no. 20;6 (September 11, 2017): E951—E960. http://dx.doi.org/10.36076/ppj.20.5.e951.
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Background: Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the factors that affect application of these processes is required, particularly regarding chronic pain. Objectives: The aims of the current study were to investigate medical students’ conceptualizations of the factors that influence application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain using interactive management (IM), model the relationships among these factors, and make recommendations to chronic pain treatment policy in light of the findings. Study Design: The current study used IM to identify and model factors that influence the application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical students’ conceptualizations of these factors. Setting: Two university classrooms. Methods: IM is a systems thinking and action mapping strategy used to aid groups in developing outcomes regarding complex issues, through integrating contributions from individuals with diverse views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive structural modeling, which in this context were employed to help medical students identify, clarify, and model influences on the application of biopsychosocial perspectives in treating chronic pain patients. Results: Results of IM group work revealed 7 core biopsychosocial approach application categories: GP attitudes, cost, GP knowledge, time, patient-doctor relationship, biomedical factors. and patient perception. GP attitudes was the most critical driver of all other competencies in the system, with cost and GP knowledge revealed as secondary drivers. Limitations: Potential differences in level of prior biopsychosocial perspective knowledge across participants and a potentially small sample size (though consistent with past research and appropriate for an exploratory study of this nature – for purposes of achieving the depth and richness of the deliberation and qualitative insights revealed by participants using the IM methodology). Conclusions: Results from this study may be used to both recommend further research on the identified factors influencing application of biopsychosocial perspectives in treatment of chronic pain and support amendment to extant health care policy, particularly with respect to cost, GP attitudes, and knowledge. Though this research claims neither that the influences identified are the only influences on biopsychosocial application, nor the order of their importance, the research does contribute to an ongoing effort to better understand the factors that influence doctors in their treatment of chronic pain.
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Gibbs, Mitchell T., Natalie M. V. Morrison, and Paul W. Marshall. "Education Improves Decision-Making of Exercise Physiologists Regarding Low Back Pain." Journal of Clinical Exercise Physiology 11, no. 1 (March 1, 2022): 12–18. http://dx.doi.org/10.31189/2165-6193-11.1.12.
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ABSTRACT Background: To investigate the efficacy of targeted education on clinical decision-making in accredited exercise physiologists. Methods: Fifty accredited exercise physiologists undertook a 4-hour targeted education session aimed to demonstrate why the biopsychosocial model is better suited to the management of chronic low back pain than the biomedical model. The pain attitudes and beliefs scale for physiotherapists and patient vignettes were collected before and after the targeted education to observe changes in beliefs and clinical decision-making. Results: A significant reduction in biomedical beliefs (P < 0.01) with no concomitant change in biopsychosocial beliefs was observed following the targeted education. Clinical decision-making significantly altered on all 8 items associated with the patient vignettes following the targeted education. Conclusion: Following targeted education, a reduction in biomedical beliefs with no concomitant change to biopsychosocial beliefs significantly altered clinical decision-making. The findings of this study support existing literature and demonstrate changes in attitudes and beliefs following education impact clinical decision-making in accredited exercise physiologists. Education interventions should focus on informing practitioners of the benefits of the biopsychosocial model as compared to the biomedical model for management of chronic low back pain rather than simply teaching biopsychosocial theory and application.
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Wirick, Dawn M., and Lee A. Teufel-Prida. "Chronic Lower Back Pain." Family Journal 26, no. 1 (January 2018): 86–89. http://dx.doi.org/10.1177/1066480718756845.
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Chronic lower back pain is a major health concern involving physical, financial, and social costs for many patients and their family members. Contemporary pain management is guided by the biopsychosocial model in which a professional counselor can contribute to recovery through integrated behavioral health care. Cognitive behavioral therapy (CBT) and behavioral activation interventions are effective in breaking the cycle of chronic pain. Successful outcomes involve partners and family members in CBT, education, and structural family interventions. A case study is presented to examine thoughts and feelings associated with chronic lower back pain. CBT and family interventions contribute to recovery of functions, meaningful roles, and health in relationships.
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Baria, Ariel M., Sanjog Pangarkar, Gary Abrams, and Christine Miaskowski. "Adaption of the Biopsychosocial Model of Chronic Noncancer Pain in Veterans." Pain Medicine 20, no. 1 (May 2, 2018): 14–27. http://dx.doi.org/10.1093/pm/pny058.
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Edgar, Nathan, Christopher Clifford, Seth O'Neill, Carles Pedret, Paul Kirwan, and Neal L. Millar. "Biopsychosocial approach to tendinopathy." BMJ Open Sport & Exercise Medicine 8, no. 3 (August 2022): e001326. http://dx.doi.org/10.1136/bmjsem-2022-001326.
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Tendinopathy describes a spectrum of changes that occur in damaged tendons, leading to pain and reduced function that remains extremely challenging for all clinicians. There is an increasing awareness of the influence that psychological and psychosocial components, such as self-efficacy and fear-avoidance, have on rehabilitation outcomes in musculoskeletal medicine. Although it is widely accepted that psychological/psychosocial factors exist in tendinopathy, there is currently a distinct lack of trials measuring how these factors affect clinical outcomes. Biopsychosocial treatments acknowledge and address the biological, psychological and social contributions to pain and disability are currently seen as the most efficacious approach to chronic pain. Addressing and modulating these factors are crucial in the pathway of personalised treatments in tendinopathy and offer a real opportunity to drive positive outcomes in patients. In this education review, we also provide the current evidence-based guidance on psychological and psychosocial developments in musculoskeletal medicine and how these may be translated to treating tendinopathy using a biopsychosocial model.
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Gibson, Carolyn J., Joseph Grasso, Yongmei Li, Natalie Purcell, Jennifer Tighe, Kara Zamora, Francesca Nicosia, and Karen H. Seal. "An Integrated Pain Team Model: Impact on Pain-Related Outcomes and Opioid Misuse in Patients with Chronic Pain." Pain Medicine 21, no. 9 (February 25, 2020): 1977–84. http://dx.doi.org/10.1093/pm/pnaa003.
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Abstract Objective Biopsychosocial integrated pain team (IPT) care models are being implemented in Veterans Health Administration (VA) and other health care systems to address chronic pain and reduce risks related to long-term opioid therapy, with little evaluation of effectiveness to date. We examined whether IPT improves self-reported pain-related outcomes and opioid misuse. Design Single-group quality improvement study. Setting Large VA health care system. Subjects Veterans with chronic pain (N = 99, 84% male, mean age [SD] = 60 [13] years). Methods Using paired t tests and Wilcoxon matched-pairs signed-ranks tests, we examined pain experience (Brief Pain Inventory, Pain Catastrophizing Scale), opioid misuse (Current Opioid Misuse Measure), treatment satisfaction (Pain Treatment Satisfaction Scale), and pain management strategies among patients with chronic pain before and after three or more IPT encounters. Results After an average (SD) of 14.3 (9) weeks engaged in IPT, patients reported improvement in pain interference (mean [SD] = 46.0 [15.9] vs 40.5 [16.2], P < 0.001), pain catastrophizing (mean [SD] = 22.9 [13.0] vs 19.3 [14.1], P = 0.01), treatment satisfaction (i.e., “very satisfied” = 13.1% at baseline vs 25.3% at follow-up, P = 0.01), and reduced opioid misuse (mean [SD] = 11.0 [7.5] vs 8.2 [6.1], P = 0.01). Patients reported increased use of integrative (i.e., acupuncture, 11% at baseline vs 26% at follow-up, P < 0.01) and active pain management strategies (i.e., exercise, 8% at baseline vs 16% at follow-up, P < 0.01) and were less likely to use only pharmacological pain management strategies after IPT engagement (19% at baseline vs 5% at follow-up, P < 0.01). Conclusions Biopsychosocial, integrated pain care may improve patient-centered outcomes related to opioid misuse and the subjective experience and nonpharmacological self-management of chronic pain.
Dissertations / Theses on the topic "Biopsychosocial model of chronic pain"
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Ord, Jonathan S. "Biopsychosocial Factors in Chronic Spine-Related Pain: Contributions to Pain Intensity and Perceived Disability." ScholarWorks@UNO, 2010. http://scholarworks.uno.edu/td/1112.
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Psychological and contextual factors play an important role in the development and maintenance of chronic spine-related pain, and effective treatment of pain-related conditions requires an understanding of how these factors contribute to pain and disability. The present study examined the relative contributions of spine pathology, psychological complications, and demographic factors to perceived pain intensity and disability in patients with chronic spine-related pain. Because most patients were assessed in the context of a compensable injury, exaggeration of symptoms and disability was systematically controlled for using multiple validity indicators. A high prevalence of psychological complications was observed in the present sample. Analysis indicated that psychological factors were not significantly related to pain intensity, but were significantly related to reported pain-related disability. Further, psychological factors were found to predict pain-related disability beyond demographics, medical findings, and pain intensity. Clinical implications of these findings are discussed.
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Kemp, Kristen A. "An Exploratory Study of Biopsychosocial Factors Related to Chronic Pain Treatment Selection." Xavier University Psychology / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=xupsy1597346234202876.
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Scott, Suzanne, and n/a. "Attachment Style and Chronic Pain Syndrome: The Importance of Psychological and Social Variables in the Biopsychosocial Model of Chronic Pain." Griffith University. School of Psychology, 2006. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20070326.114910.
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The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.
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Scott, Suzanne. "Attachment Style and Chronic Pain Syndrome: The Importance of Psychological and Social Variables in the Biopsychosocial Model of Chronic Pain." Thesis, Griffith University, 2006. http://hdl.handle.net/10072/365870.
Full textAbstract:
The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Psychology
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Douglas, Clint. "The impact of pain on the quality of life of people with multiple sclerosis." Thesis, Queensland University of Technology, 2007. https://eprints.qut.edu.au/16523/1/Clint_Douglas_Thesis.pdf.
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This thesis was concerned with determining the scope, nature and impact of pain on quality of life (QOL) among a community-based sample of people with multiple sclerosis (MS). An analysis of the research literature on pain in MS reveals that pain is a significant problem which has historically been underinvestigated and is currently poorly understood. The vast majority of the published literature consists of prevalence studies, descriptive research and clinical reports. Where available, empirical data are often limited by methodological and analytical problems such that substantive conclusions about the scope and nature of MS-related pain remain unclear. Among the most fundamental issues is the extent to which pain is problematic in a population which is already impaired by other physical disabilities. Little is known about how pain contributes to MS-related disability, distress and QOL. Moreover, research examining the psychosocial aspects of MS-related pain is noticeably absent. It is clear that there are substantial gaps in the literature and that many basic questions about the scope, nature and impact of pain problems among individuals with MS remain unanswered. Thus the primary aim of this study was to begin to fill some of these gaps by systematically investigating the following research questions: (1) What is the prevalence and nature of pain experienced by people with MS? (2) What is the impact of pain on the QOL of people with MS, over and above the impact of disability itself? (3) To what extent do physical and psychosocial factors influence adjustment to chronic pain in people with MS? (4) What meaning is given to the pain experience by people with MS?
The present study utilised a multimethod research design involving cross-sectional postal survey, structured in-person pain interviews and focus groups. Survey respondents were a 219-person sample recruited from the Queensland MS Society membership database via systematic random sampling. All participants completed a piloted questionnaire containing questions about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the previous two weeks. Respondents who reported pain then completed face-to-face structured pain interviews assessing pain characteristics (viz. intensity, quality, location, extent and duration), pain-related beliefs and coping strategies, and pain management techniques used. Four focus groups were also conducted that included 32 people with MS living in the community. Study participants were a purposive sample drawn from four MS support groups located in the South-East Queensland region.
Pain was found to be common with some 67.1% of the sample reporting pain during the two weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these individuals experience chronic pain conditions characterised by moderate-to-severe pain intensity. Pain prevalence and intensity were found to be strongly correlated with QOL: physical health, psychological health, level of independence and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. Pain-related beliefs and coping strategies were also associated with and explained a significant proportion of the variance in adjustment to pain among people with MS, over and above that accomplished by demographic and MS-related variables and pain intensity. Finally, qualitative data analysis revealed four broad conceptualisations of the experience of chronic MS-related pain including: pain is pervasive, nobody understands, I'm fine, and always a factor in the equation.
These findings suggest that for people with MS, pain is an important source of distress and disability over and above that caused by neurological impairments. These data also lead to the hypothesis that recognition and effective treatment of pain would improve the QOL of people with MS, irrespective of their level of neurologic disability. Although correlational, the findings provide support for a biopsychosocial model of pain and adjustment to pain in people with MS.
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Douglas, Clint. "The impact of pain on the quality of life of people with multiple sclerosis." Queensland University of Technology, 2007. http://eprints.qut.edu.au/16523/.
Full textAbstract:
This thesis was concerned with determining the scope, nature and impact of pain on quality of life (QOL) among a community-based sample of people with multiple sclerosis (MS). An analysis of the research literature on pain in MS reveals that pain is a significant problem which has historically been underinvestigated and is currently poorly understood. The vast majority of the published literature consists of prevalence studies, descriptive research and clinical reports. Where available, empirical data are often limited by methodological and analytical problems such that substantive conclusions about the scope and nature of MS-related pain remain unclear. Among the most fundamental issues is the extent to which pain is problematic in a population which is already impaired by other physical disabilities. Little is known about how pain contributes to MS-related disability, distress and QOL. Moreover, research examining the psychosocial aspects of MS-related pain is noticeably absent. It is clear that there are substantial gaps in the literature and that many basic questions about the scope, nature and impact of pain problems among individuals with MS remain unanswered. Thus the primary aim of this study was to begin to fill some of these gaps by systematically investigating the following research questions: (1) What is the prevalence and nature of pain experienced by people with MS? (2) What is the impact of pain on the QOL of people with MS, over and above the impact of disability itself? (3) To what extent do physical and psychosocial factors influence adjustment to chronic pain in people with MS? (4) What meaning is given to the pain experience by people with MS? The present study utilised a multimethod research design involving cross-sectional postal survey, structured in-person pain interviews and focus groups. Survey respondents were a 219-person sample recruited from the Queensland MS Society membership database via systematic random sampling. All participants completed a piloted questionnaire containing questions about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the previous two weeks. Respondents who reported pain then completed face-to-face structured pain interviews assessing pain characteristics (viz. intensity, quality, location, extent and duration), pain-related beliefs and coping strategies, and pain management techniques used. Four focus groups were also conducted that included 32 people with MS living in the community. Study participants were a purposive sample drawn from four MS support groups located in the South-East Queensland region. Pain was found to be common with some 67.1% of the sample reporting pain during the two weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these individuals experience chronic pain conditions characterised by moderate-to-severe pain intensity. Pain prevalence and intensity were found to be strongly correlated with QOL: physical health, psychological health, level of independence and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. Pain-related beliefs and coping strategies were also associated with and explained a significant proportion of the variance in adjustment to pain among people with MS, over and above that accomplished by demographic and MS-related variables and pain intensity. Finally, qualitative data analysis revealed four broad conceptualisations of the experience of chronic MS-related pain including: pain is pervasive, nobody understands, I'm fine, and always a factor in the equation. These findings suggest that for people with MS, pain is an important source of distress and disability over and above that caused by neurological impairments. These data also lead to the hypothesis that recognition and effective treatment of pain would improve the QOL of people with MS, irrespective of their level of neurologic disability. Although correlational, the findings provide support for a biopsychosocial model of pain and adjustment to pain in people with MS.
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Hamilton, Katrina R. "Biopsychosocial Correlates of Pain Intensity and Daily Functioning in Individuals with Chronic Pain." Ohio University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1511371106049556.
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Johnson, Elisabeth A. "The Biopsychosocial Correlates of Chronic Pelvic Pain and Quality of Life in Women Attending a Specialty Pelvic Pain Clinic." Digital Archive @ GSU, 2011. http://digitalarchive.gsu.edu/nursing_diss/28.
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Background: Chronic pelvic pain (CPP) in women causes significant disability and distress. Like other chronic pain conditions, psychosocial variables likely play as key a role in the development and maintenance of CPP as physiological ones. The purposes of this study were to use the Biopsychosocial model to determine the predictors of pain and quality of life (QOL) and to specifically examine to effect of baseline catastrophizing on 12-month pain and QOL.
Methods: Secondary analysis of baseline and 12-month data collected from women presenting for CPP treatment (n = 673) at a tertiary referral center was performed. Questionnaires assessed medical symptoms, physical and mental health, abuse, trauma, catastrophizing and the main outcome measures of pain reports (McGill Pain Questionnaire) and QOL scores (adapted version of the Irritable Bowel Syndrome QOL Questionnaire).
Results: Of the 673 enrolled, 401 completed baseline questionnaires. These women were predominantly middle aged (M = 35.68, SD = 9.87), married (66%), Caucasian (78%), and educated (M = 14.83, SD = 2.55). Two hundred seventy-two women completed questionnaires at baseline and 12 months and were similar in most characteristics but reported fewer incidents of trauma and abuse, improved physical health and fewer medical symptoms. Women experienced a significant reduction in pain (t (261) = 11.23, p < .001) and improved QOL (t (257) = 6.78, p< .001). Baseline catastrophizing was a predictor of baseline pain (R2 = .42, pβ = .46, p < .001) and baseline QOL (R2 = .79, p< .001; β = .71 p < .001) with similar results at 12-month follow-up. While baseline catastrophizing contributed only 3% of the variance it remained a significant predictor of 12-month pain (R2 = .39, p < .001; β = .18, p = .003). Unexpectedly, abuse and trauma histories were not significant predictors of pain or QOL.
Conclusions: These findings contribute to the existing body of literature by confirming the complex nature of CPP and suggest that psychological processes such as catastrophizing play a vital role in CPP. Future research in CPP will benefit from the exploration of the contribution of psychological processes to CPP and the application of research from other pain conditions to gynecologic pain disorders.
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Zale, Kathryn E. "Ultrasonography Assessment of Ankle/Foot Pain: A Biopsychosocial Model." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1405621649.
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McAuley, James Henry. "Cultural influences on low back pain : extending the biopsychosocial model." Thesis, Brunel University, 2001. http://bura.brunel.ac.uk/handle/2438/5432.
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The present investigation examined the influence of cultural factors on Low Back Pain (LBP). Multiple regression techniques were used to determine the relative importance of clinical, social and psychological factors to LBP disability and cultural influences on these factors were then explored. The findings indicated that compared to clinical and social factors, LBP disability was most strongly associated with psychological factors (adjusted R2 change = 0.38, p<0.00), the most important of which was psychological distress. Clinical (adjusted R2 change = 0.11, p<0.00) or social (adjusted R2 change = 0.02, p=0.09) factors were only moderately or weakly associated with LBP disability. A series of hierarchical regression models examined the mediating role of cognitive Coping Strategies (Catastrophising & Praying and Hoping (Rosenstiel and Keefe (1983)) and Pain Control Beliefs (Control of Pain & Responsibility for management of Pain (Main and Waddell (1991)) on the relationship between LBP disability and distress. In support of the Cognitive Behavioural Mediational Model of chronic pain (Rudy and Turk, 1987), evidence was found to suggest that the relationship between LBP disability and distress was largely dependent upon Coping Strategies and Pain Control Beliefs. The findings also suggested that Pain Control Beliefs were largely dependent upon Coping strategies, although these relationships varied between specific Pain Control Beliefs and Coping Strategies. The study found evidence to suggest that certain self report questionnaires which are commonly used to assess cognitive factors associated with LBP may not have robust cross cultural reliabilities as measured by Cronbach's Alpha (Cronbach 1951) (Praying and Hoping (P&H) subscale of the Coping Strategies Questionnaire (CSQ) Rosensteil and Keefe 1983; Pain Responsibility (PR) subscale of the Pain Locus of Control (PLC) Main and Waddell 1991). The findings indicated that when used in their present form, these self reported questionnaires may provide inconsistent results with South Asian, African-born or Muslim LBP patients. The study provided evidence for the role of Cultural factors (self defined Ethnicity, Country of Birth and reported Religious Affiliation) on the experience of LBP. Although the relationship between cultural factors and LBP was generally weak (R2 change < 0.15), it appeared that South Asian, African-born and Muslim patients experienced LBP significantly worse than other LBP patients. The cultural group differences were strongest for the "passive" coping strategy "Praying and Hoping" (Rosensteil and Keefe 1983) (R2 change = 0.15, p < 0.001). The most apparent cultural differences were for Muslim patients who compared with all other Religious groups consistently reported the worst experience of LBP. Muslim LBP patients were clinically more disabled than either Christian (mean Roland and Morris Disability Questionnaire (RMDQ) difference (Roland and Morris, 1983) = 4.13) or other (mean RMDQ difference = 4.29) LBP patients. The statistical control of clinical variables in the regression models led to the conclusion that these groups of patients had a more "chronic" experience of LBP. Religious affiliation may help to identify LBP patients who present to secondary care with more chronic symptoms of LBP. Standardisation of self report questionnaire in these cultural groups may improve the precision of these findings. The present investigation was primarily descriptive in that reasons for cultural differences were not empirically examined. However the study findings suggest potentially fruitful areas for further investigation particularly that work on the meaning of "Praying" as a coping strategy and on its relationship with LBP disability for non-Christian groups would appear warranted.
Books on the topic "Biopsychosocial model of chronic pain"
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Khouzam, Hani Raoul. Psychiatry and Chronic Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199981830.003.0007.
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This chapter reviews some of the connections between psychiatry and chronic pain, highlighting the role that psychiatrists can play in diagnosing and treating chronic pain. Identifying and addressing the various psychiatric components of chronic pain can significantly contribute to successful rehabilitation, recovery, and improved overall functioning.Psychiatric models (gate control, diathesis/stress, biopsychosocial–spiritual approaches, cognitive-behavioral transactional and cognitive-behavioral fear avoidance) are described to provide a theoretical basis for understanding the development and the clinical management of chronic pain.This chapter also describes how psychiatrists can collaborate with primary care providers in managing chronic pain within the framework of multidisciplinary treatment teams.It is important for healthcare professionals, regulators, law enforcement personnel, and legislators to identify the connection between psychiatry and chronic pain in the context of its diagnosis, management, and treatment.
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McCarron, Robert M., Amir Ramezani, Ian Koebner, Samir J. Sheth, and Jessica Palka. Integrated Chronic Pain and Psychiatric Management. Edited by Robert E. Feinstein, Joseph V. Connelly, and Marilyn S. Feinstein. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190276201.003.0023.
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Both physical pain and psychiatric disorders are widely prevalent, and collectively they account for the most frequently presenting complaints in the primary care setting. These conditions are a complex challenge for both the patient and provider, with frequent high use of medical services and increased morbidity. The Integrated Behavioral Pain Medicine (IBPM) treatment model incorporates a multidisciplinary, biopsychosocial, team-based approach for patients who have chronic and largely treatment-refractory pain. IBPM uses an integrated care team of providers and coordinators, who collectively work with the chronic pain patient to individualize a pain management plan, which may include pharmacologic management, cognitive-behavioral therapy, trauma-focused therapy, biofeedback, mindfulness, acupuncture, nutrition, behavioral weight and sleep management, and physical therapy. Ideally, primary care providers will refer patients to an IBPM model of care, but if the treatment model is not available in a specific area, a piecemeal approach with partial use of services is recommended.
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Choinière, Manon, and M. Gabriella Pagé. Three determinants of pain. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0008.
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Building on the foundations laid by the gate control theory, Melzack and Casey theorized in 1968 the existence of three separate, yet related determinants of pain: sensory–discriminative, affective–motivational, and cognitive–evaluative. These determinants have roots in separate neurophysiological pathways that modulate the pain experience. The importance of this paper lies in its theoretical contribution to our understanding of pain. Melzack and Casey’s seminal paper, written almost 50 years ago, is not only still contemporary, as evidenced by the internationally agreed upon definition of chronic pain (the IASP taxonomy) but has also contributed to moving from a biomedical understanding of pain to a biopsychosocial model of evaluating and treating pain. This conceptualization of pain continues to influence the way pain is evaluated and is the foundation of the use of non-pharmacological and non-interventional modalities for the treatment of pain (e.g. psychological techniques), and multidisciplinary approaches to pain treatment.
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Lal, Mira, and Johannes Bitzer. Disease severity, pain, and patient perception: themes in clinical practice and research. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198749547.003.0006.
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Chapter 6 begins with a discussion of how to assess disease severity. It then moves on to the concepts of physical and emotional pain, which are particularly useful for understanding pelvic floor problems, infertility, pregnancy loss, and chronic pelvic pain. All of these have biological, psychological, and social features associated with their aetiopathogenesis, and presentations. To manage these conditions effectively, it is crucial to understand the patient's perception. First, pelvic/perineal dysfunction is addressed. This includes the loss of urinary and bowel continence, with deleterious effects on biopsychosocial health. The condition is common, and can cause severe morbidity following any delivery mode, including a planned caesarean. This is illustrated by an evaluation of biopsychosocial morbidity, quantified by categorising patient perceptions of severity of incontinence, and related sexual problems. The psychosomatic repercussions of infertility, miscarriage, stillbirth, and chronic pelvic pain are then appraised. Since physical and emotional pain can affect these conditions, timely recognition and biopsychosocial management helps promote positive physical, mental and social health. A special focus is given to endometrial implants outside the uterine cavity (endometriosis). These can cause chronic pelvic pain, infertility, and pregnancy loss, but may be symptomless. Their aetiology remains unclear. Ovulation suppression relieves pain and treatment is tentative, with removal of the affected pelvic organs being an extreme option. Even after this, however, symptoms may persist. A pathway using the tailored psychosomatic approach is advocated to provide patient-centred care where indicated.
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Pridmore, Saxby. Managing Chronic Pain: A Biopsychosocial Approach. Taylor & Francis Group, 2002.
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Pridmore, Saxby. Managing Chronic Pain: A biopsychosocial approach. Informa Healthcare, 2002.
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Andrew, Block, Kremer Edwin F, and Fernandez Ephrem, eds. Handbook of pain syndromes: Biopsychosocial perspectives. Mahwah, N.J: Lawrence Erlbaum Associates, 1999.
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Fernandez, Ephrem, Andrew R. Block, and Edwin Kremer. Handbook of Pain Syndromes: Biopsychosocial Perspectives. Taylor & Francis Group, 2014.
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(Editor), Andrew R. Block, Ephrem Fernandez (Editor), and Edwin Kremer (Editor), eds. Handbook of Pain Syndromes: Biopsychosocial Perspectives. Lawrence Erlbaum, 1998.
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Fernandez, Ephrem, Andrew R. Block, and Edwin Kremer. Handbook of Pain Syndromes: Biopsychosocial Perspectives. Taylor & Francis Group, 2013.
Find full textBook chapters on the topic "Biopsychosocial model of chronic pain"
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Tripp, Dean A. "A Biopsychosocial Therapy Model for Chronic Prostatitis/Chronic Pelvic Pain Syndrome." In Chronic Prostatitis/Chronic Pelvic Pain Syndrome, 143–63. Totowa, NJ: Humana Press, 2008. http://dx.doi.org/10.1007/978-1-59745-472-8_12.
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Streltzer, Jon. "Chronic Pain." In Biopsychosocial Approaches in Primary Care, 81–91. Boston, MA: Springer US, 1997. http://dx.doi.org/10.1007/978-1-4615-5957-3_7.
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Zernikow, Boris, Holger Kriszio, Michael Frosch, Michael Dobe, and Julia Wager. "Pain Disorder: A Biopsychosocial Disease." In Practical Treatment Options for Chronic Pain in Children and Adolescents, 7–34. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-19201-3_2.
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Kriszio, Holger, Julia Wager, Michael Dobe, Tanja Hechler, and Boris Zernikow. "Pain Disorder: A Biopsychosocial Disease." In Practical Treatment Options for Chronic Pain in Children and Adolescents, 5–32. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-37816-4_2.
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Turner, Mary Elizabeth, and Marian Fireman. "Evaluating the Biopsychosocial Milieu of Chronic Pain." In Treating Comorbid Opioid Use Disorder in Chronic Pain, 35–45. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-29863-4_4.
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Essner, Bonnie S., Susan T. Tran, and Marissa L. Koven. "Biopsychosocial Approaches to Pediatric Chronic Pain Management." In Opioid Therapy in Infants, Children, and Adolescents, 283–96. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-36287-4_16.
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Gatchel, Robert J., Robbie Haggard, Christina Thomas, and Krista J. Howard. "Biopsychosocial Approaches to Understanding Chronic Pain and Disability." In Handbook of Pain and Palliative Care, 1–16. New York, NY: Springer New York, 2011. http://dx.doi.org/10.1007/978-1-4419-1651-8_1.
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Gatchel, Robert J., Robbie Haggard, Christina Thomas, and Krista J. Howard. "Biopsychosocial Approaches to Understanding Chronic Pain and Disability." In Handbook of Pain and Palliative Care, 3–22. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-95369-4_1.
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Garroway, Andrea M., and Bruce Rybarczyk. "Aging, chronic disease, and the biopsychosocial model." In APA handbook of clinical geropsychology, Vol. 1: History and status of the field and perspectives on aging., 563–86. Washington: American Psychological Association, 2015. http://dx.doi.org/10.1037/14458-024.
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Sommer, Claudia. "Neuropathic Pain Model, Chronic Constriction Injury." In Encyclopedia of Pain, 2072–75. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-28753-4_2678.
Full textConference papers on the topic "Biopsychosocial model of chronic pain"
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Reber, Howard A. "The Cat Model of Chronic Pancreatitis Intrapancreatic Pressures and the Pathophysiology of Pain." In Proceedings of the 92nd Course of the International School of Medical Sciences. WORLD SCIENTIFIC, 1999. http://dx.doi.org/10.1142/9789814447249_0008.
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Jiang, L., Z. H. Liang, Z. Y. Bo, and Z. P. Li. "Assessment on abdominal acupuncture for chronic neck pain based on general linear model." In 2012 International Conference on System Simulation (ICUSS 2012). IET, 2012. http://dx.doi.org/10.1049/cp.2012.0545.
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Elferinga, Achim, Cornelia Rollia, Urs Müllerb, Özgür Tamcanb, and Anne F. Mannionc. "Maladaptive Back Beliefs and Low Back Pain in Nurses: A Longitudinal Study." In Applied Human Factors and Ergonomics Conference. AHFE International, 2021. http://dx.doi.org/10.54941/ahfe100514.
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This population-based longitudinal questionnaire study examined whether back beliefs predicted increased low back pain (LBP) one year after baseline, comparing the phenomenon in nurses versus other participants. A random sample of 2’860 individuals participated. At one-year follow-up 1’445 questionnaires were returned. At baseline and follow-up, back beliefs were assessed with the Back Beliefs Questionnaire (BBQ) and LBP was assessed using a standardized pain intensity item and pain manikin. Cross-lagged structural equation modeling was used to estimate the prospective risk path from BBQ at baseline to LBP at follow-up. A model comparison test evaluated whether paths differed between 59 nurses and 1’383 other respondents. The cross-lagged path model fitted the empirical data well (CFI = 0.91; RMSEA = 0.04). In nurses, the longitudinal path from BBQ to LBP at follow-up (β=0.30, p=.013) and the cross-sectional association between BBQ and LBP at follow-up (β = 0.42, p = .031) were more positive than in others (longitudinal path: β = 0.05, p = .023; cross-sectional path: β = 0.06, p = .062). The biopsychosocial model of LBP and maladaptive back beliefs should be addressed in educational occupational health interventions for nurses.
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Jurenikova, Petra. "PAIN ASSESSMENT IN PATIENS, IN WHOM VASCULAR PROCEDURES USING PROSTHETIC GRAFTS ARE INDICATED, BASED ON THE DYNAMIC MODEL OF PSYCHOLOGICAL PROCESSES IN CHRONIC PAIN." In 4th SGEM International Multidisciplinary Scientific Conferences on SOCIAL SCIENCES and ARTS Proceedings. STEF92 Technology, 2017. http://dx.doi.org/10.5593/sgemsocial2017/33/s12.058.
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Nguyen, G. P., J. A. Biurrun Manresa, M. Curatolo, T. B. Moeslund, and O. K. Andersen. "A prediction model for differentiating chronic pain patients and healthy subjects based on withdrawal reflex EMG signals." In 5th International IEEE/EMBS Conference on Neural Engineering (NER 2011). IEEE, 2011. http://dx.doi.org/10.1109/ner.2011.5910496.
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Henderson, Sarah E., Alejandro J. Almarza, Scott Tashman, and Amy L. McCarty. "Temporomandibular Joint Kinematics of the Rabbit Model With Mechanically Disrupted Occlusion." In ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53292.
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Degeneration of the articulating surfaces and pain associated with temporomandibular joint (TMJ) dysfunction are the primary symptoms of TMJ disorders (TMDs), where normal life activities such as eating, talking, and even sleeping may be drastically impaired [1–3]. To accelerate the discovery of effective therapeutic interventions for the treatment of TMD pain, we have been establishing a novel non-invasive approach for objectively assessing the presence of joint hypersensitivity. Our approach to identify chronic joint pain is based on evidence that all of the etiological factors associated with TMD pain implicate remodeling and degeneration of the joint in response to alterations in motion and loading. The injury model used for this study was a reversible, mechanical model through splint placement on the molars. It is hypothesized that arthrokinematic analysis will identify a specific pattern of functional changes that constitute a signature for the presence of irreversible damage.
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Gladović, Neven, Luka Leško, and Martina Fudurić. "Effectiveness of manual yumeiho therapy and exercise on depression and neuropathic pain in patients suffering from chronic nonspecific low back pain." In 12th International Conference on Kinanthropology. Brno: Masaryk University Press, 2020. http://dx.doi.org/10.5817/cz.muni.p210-9631-2020-27.
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Introduction: Chronic low back pain is the leading cause of disability, which reduces quality of life and increases the healthcare costs. Psychosocial factors (depression, kinesiophobia and somatization) may also have an important role in the appearance and duration of chronic nonspecific low back pain. Depression may predispose low back pain, while the chronicity of pain affects the degree of disability, which is also related to mental health. Many studies suggest the association between depression and low back pain by explaining a significant physiological link. Different types of manual therapy are used in the treatment of chronic low back pain, but recent studies suggest that a rehabilitation models which combine manual therapy and exercise, provide better results compared to individual (separate) applications. The aim of this research was to examine the effects of the rehabilitation program, which in-cludes manual yumeiho therapy and exercise, on depression in people suffering from chronic nonspecific low back pain. Methods: The study included 21 participants, aged 40 to 60 (M=51.1, SD=5.9) who suffer from chronic nonspecific low back pain. The study included the initial and final depression test and the initial and final neuropathic pain test. Between the initial and the final testing, a three-week therapeutic procedure of yumeiho manual therapy and exercise was performed (15 treatments). Repeated estimates of depression and neuropathic pain were tested 30 and 60 days after the implementation of the rehabilitation protocol. Results: Statistically significant improvements were noted between the initial and the final test in both observed variables. Significant improvements (lower depression and neuropathic pain) have also been noted 30 and 60 days after the implementation of the rehabilitation pro-tocol (in relation to the initial state). Conclusion: The findings indicate that the rehabilitation protocol, involving manual yumeiho therapy and exercise, is an effective method for treating depression and neuropathic pain in people suffering from chronic nonspecific low back pain. Considering the lack of research on the effects of manual therapy by yumeiho technique, the results contribute to a better under-standing of technique which, although used in practice, has not been suficiently explored. Further research is required, on comparing this rehabilitation model to other methods, as well as longer follow-up in the post-rehabilitation period.
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McGilvray, Kirk C., Amy S. Lyons, A. Simon Turner, John D. MacGillivray, Struan H. Coleman, and Christian M. Puttlitz. "Shoulder Tendon Repair Biomechanics Using a Polyurethane Patch in a Chronic Ovine Defect Model." In ASME 2007 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2007. http://dx.doi.org/10.1115/sbc2007-175337.
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Rotator cuff disorders are one of the most common soft tissue injuries of the musculoskeletal system [1], second only to lower back pain presentations in clinical frequency [2]. Surgical repairs of chronic, massive rotator cuff tears are associated with a high rate of complications, typically by full or partial re-rupture of the repair [3,4]. The literature is replete with clinical retrospective studies or evaluation of cadaveric shoulders [5], however these studies do not address the in vivo healing characteristics of a given surgical repair. The purpose of this study was to quantitatively describe the degree of shoulder healing via biomechanical analyses using an ovine chronic infraspinatus model that was repaired with and without a polyurethane scaffold rotator cuff repair (RCR) patch.
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Moreira, Larissa Iulle, Anderson Bessa da Costa, Nivio Ziviani, Manoel Jacobsen Teixeira, Jefferson Rosi Jr, Marcelo Nishio, Daniella Castro Araujo, Adriano Veloso, and Daniel Ciampi de Andrade. "An artificial intelligence solution to detect and manage non-response to chronic-pain treatment." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.745.
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Chronic Pain (CP) affects one in five people in developing countries, and is the most frequent reason motivating medical visits. Some CP types rank as the most common symptomatic diseases affecting humans worldwide (eg, tension-type headache), and the most common cause of years lived with disability (eg, low back pain). Despite the high costs related to the diagnosis and management of CP, up to 40% of patients remain symptomatic despite best medical therapy. The relative inefficiency of CP management stems from several causes, lack of good predictors of response to treatment being one of them. Inefficient prognostication leads to low response to treatment, high odds of side-effect and iatrogeny, especially in CP syndromes where lesion to somatic or neural tissues are not the driving mechanisms leading to pain (primary headaches, low-back pain, fibromyalgia). We have developed an electronic medical record system specific for pain management and used it in 611 prospective patients addressed to our Institution. We then used structured and unstructured data from the first visit and used as an end-point of good outcome the two higher strata of the patients’ Global Impression of Change score (very much and much improved) systematically collected at the last visit, which took place within 12 months from the first. By using state of art AI algorithms in an interpretable approach, we obtained a list of 12 highly predictable variables, which included pain in specific pain areas of the body, sex, pain pattern and temporal profile. Using these variables, and their complex relationship, we developed a machine learning model that predicted a good long-term outcome at the moment of the first visit, yielding a sensitivity and specificity of 0.69 and 0.73, respectively, with an area under the curve of 0.71. When imputed with variables from the second visit, AUC numbers reached 0.85. Business Model: given the challenges that health systems around the world are facing, the main target today is to make the shift from a payper-use mode to a value-based approach. This will bring the patient to the center of medical decisions. Chronic pain is an ideal scenario to test new strategies directed to these goals. In fact, our strategy allowed the identification of patients who would not respond to traditional therapeutic approaches before they were implemented, potentially saving time, resources and mitigating suffering. Public health systems and integrated health operators can be greatly benefited using this tool by increasing treatment effectiveness and reducing losses. Lower costs for all enables more people to access good health faster. Market share: large health conglomerates with closed loops of care including diagnostic and health-care provider facilities using electronic data record systems.
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Nicoll, Steven B., Christopher K. Hee, Martin B. Davis, and Beth A. Winkelstein. "A Rat Model of Osteoarthritic Temporomandibular Joint Pain: Mechanically-Induced Behavioral Hypersensitivity and Histologic Modifications." In ASME 2007 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2007. http://dx.doi.org/10.1115/sbc2007-176520.
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Orofacial pain associated with osteoarthritis (OA) in the temporomandibular joint (TMJ) is a significant clinical problem [1]. The pathophysiologic and cellular mediators that underlie the development of such chronic orofacial pain are not well understood, nor has a relationship to mechanical loading been defined. Several experimental models have been developed to examine causative factors in TMJ OA progression and joint pathology. Such models often involve intra-articular injections or surgical manipulation of tissue structures in order to alter joint kinematics and stability [2–6]. For example, severing of the discal attachments followed by anterior displacement of the disc has been employed in a rabbit model, while disc perforation and scraping of the condylar surface have been used in sheep models to induce OA symptoms [2,3]. A limitation of the above approaches is that they introduce artificial damage to the joint structures and do not approximate the clinical disorder of mechanically-induced TMJ OA. Therefore, the goal of this pilot study was to develop a novel model of TMJ OA via non-invasive and mechanically relevant methods that could produce behavioral hypersensitivity (mechanical allodynia) suggestive of pain symptoms and histological changes in the TMJ consistent with osteoarthritic pathology.
Reports on the topic "Biopsychosocial model of chronic pain"
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Skelly, Andrea C., Roger Chou, Joseph R. Dettori, Erika D. Brodt, Andrea Diulio-Nakamura, Kim Mauer, Rongwei Fu, et al. Integrated and Comprehensive Pain Management Programs: Effectiveness and Harms. Agency for Healthcare Research and Quality (AHRQ), October 2021. http://dx.doi.org/10.23970/ahrqepccer251.
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Objectives. To evaluate the effectiveness and harms of pain management programs that are based on the biopsychosocial model of care, particularly in the Medicare population. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) from 1989 to May 24, 2021; reference lists; and a Federal Register notice. Review methods. Given lack of consensus on terminology and program definition for pain management, we defined programs as integrated (based in and integrated with primary care) and comprehensive (referral based and separate from primary care) pain management programs (IPMPs and CPMPs). Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) comparing IPMPs and CPMPs with usual care or waitlist, physical activity, pharmacologic therapy, and psychological therapy in patients with complex acute/subacute pain or chronic nonactive cancer pain. Patients needed to have access to medication support/review, psychological support, and physical function support in programs. Meta-analyses were conducted to improve estimate precision. We classified the magnitude of effects as small, moderate, or large based on predefined criteria. Strength of evidence (SOE) was assessed for the primary outcomes of pain, function, and change in opioid use. Results. We included 57 RCTs; 8 evaluated IPMPs and 49 evaluated CPMPs. Compared with usual care or waitlist, IPMPs were associated with small improvements in pain in the short and intermediate term (SOE: low) and in function in the short term (SOE: moderate), but there were no clear differences at other time points. CPMPs were associated with small improvements in pain immediately postintervention (SOE: moderate) but no differences in the short, intermediate, and long term (SOE: low); for function, improvements were moderate immediately postintervention and in the short term; there were no differences in the intermediate or long term (SOE: low at all time points). CPMPs were associated with small to moderate improvements in function and pain versus pharmacologic treatment alone at multiple time frames (SOE: moderate for function intermediate term; low for pain and function at all other times), and with small improvements in function but no improvements in pain in the short term when compared with physical activity alone (SOE: moderate). There were no differences between CPMPs and psychological therapy alone at any time (SOE: low). Serious harms were not reported, although evidence on harms was insufficient. The mean age was 57 years across IPMP RCTs and 45 years across CPMP RCTs. None of the trials specifically enrolled Medicare beneficiaries. Evidence on factors related to program structure, delivery, coordination, and components that may impact outcomes is sparse and there was substantial variability across studies on these factors. Conclusions. IPMPs and CPMPs may provide small to moderate improvements in function and small improvements in pain in patients with chronic pain compared with usual care. Formal pain management programs have not been widely implemented in the United States for general populations or the Medicare population. To the extent that programs are tailored to patients’ needs, our findings are potentially applicable to the Medicare population. Programs that address a range of biopsychosocial aspects of pain, tailor components to patient need, and coordinate care may be of particular importance in this population.
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Rongwei Fu, Benjamin Morasco, Devan Kansagara, and Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain. Agency for Healthcare Research and Quality (AHRQ), October 2021. http://dx.doi.org/10.23970/ahrqepccer250.
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Objectives. To evaluate the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases, reference lists of included studies, submissions received after Federal Register request were searched to July 2021. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence. Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as high-THC to CBD ratio, comparable THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or synthetic. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square and the I2 test for inconsistency. Magnitude of benefit was categorized into no effect or small, moderate, and large effects. Results. From 2,850 abstracts, 20 RCTs (N=1,776) and 7 observational studies (N=13,095) assessing different cannabinoids were included; none of kratom. Studies were primarily short term, and 75 percent enrolled patients with a variety of neuropathic pain. Comparators were primarily placebo or usual care. The strength of evidence (SOE) was low, unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=28%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=24%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 30% vs. 8%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 22% vs. 16%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.20 to 2.78, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=39%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=0%; nausea: 2 RCTs, N=302, 12% vs. 6%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=0%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34). We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=50%; SOE: moderate). Evidence on whole-plant cannabis, topical CBD, low-THC to CBD, other cannabinoids, comparisons with active products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) and study withdrawal due to adverse events with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products in short-term treatment (1 to 6 months). Evidence for whole-plant cannabis, and other comparisons, outcomes, and PBCs were unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, Benjamin J. Morasco, Devan Kansagara, Shelley Selph, Rebecca Holmes, and Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for iii Chronic Pain: 2022 Update. Agency for Healthcare Research and Quality (AHRQ), September 2022. http://dx.doi.org/10.23970/ahrqepccer250update2022.
Full textAbstract:
Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to April 4, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From 3,283 abstracts, 21 RCTs (N=1,905) and 8 observational studies (N=13,769) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 59 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.
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Chou, Roger, Azrah Y. Ahmed, Christina Bougatsos, Benjamin J. Morasco, Rebecca Holmes, Terran Gilbreath, and Rongwei Fu. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2022 Update—Surveillance Report 2. Agency for Healthcare Research and Quality (AHRQ), January 2023. http://dx.doi.org/10.23970/ahrqepccer250.2022updatesr2.
Full textAbstract:
Objectives. To update the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain using a living systematic review approach. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases; reference lists of included studies; and submissions received after Federal Register request were searched to October 24, 2022. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence (SOE). Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as comparable THC to CBD ratio, high-THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or a synthetic product. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square test and the I2 statistic. Magnitude of benefit was categorized as no effect or small, moderate, and large effects. Results. From a total of 3,568 abstracts, 21 RCTs (N=1,905) and 9 observational studies (N=15,079) assessing different cannabinoids were included; none evaluated kratom. Studies were primarily short term, and 60 percent enrolled patients with neuropathic pain. Comparators were primarily placebo or usual care. The SOE was low unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in pain severity (7 RCTs, N=632, 0 to 10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=39%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=32%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation, and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 31.0% vs. 8.0%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 8.0% vs. 1.2%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.19 to 2.77, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390, 0 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=48%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=28%; nausea: 2 RCTs, N=302, 12.3% vs. 6.1%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We also found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=40%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34); outcomes assessing benefit were not reported or insufficient. We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=58%; SOE: moderate). Evidence (including observational studies) on whole-plant cannabis, topical or oral CBD, low-THC to CBD, other cannabinoids, comparisons with active products or between cannabis-related products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) with high and comparable THC to CBD ratio extracted cannabinoids and synthetic products during short-term treatment (1 to 6 months); high-THC to CBD ratio products were also associated with increased risk of withdrawal due to adverse events. Evidence for whole-plant cannabis and other comparisons, outcomes, and plant-based compounds was unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.