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Miaskowski, Christine, Fiona Blyth, Francesca Nicosia, Mary Haan, Frances Keefe, Alexander Smith i Christine Ritchie. "A Biopsychosocial Model of Chronic Pain for Older Adults". Pain Medicine 21, nr 9 (17.12.2019): 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 i Robert J. Gatchel. "The Biopsychosocial Model of the Assessment, Prevention, and Treatment of Chronic Pain". US Neurology 12, nr 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, nr 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 i 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, nr 2 (16.01.2023): 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, nr 20;6 (11.09.2017): 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 i Paul W. Marshall. "Education Improves Decision-Making of Exercise Physiologists Regarding Low Back Pain". Journal of Clinical Exercise Physiology 11, nr 1 (1.03.2022): 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., i Lee A. Teufel-Prida. "Chronic Lower Back Pain". Family Journal 26, nr 1 (styczeń 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 i Christine Miaskowski. "Adaption of the Biopsychosocial Model of Chronic Noncancer Pain in Veterans". Pain Medicine 20, nr 1 (2.05.2018): 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 i Neal L. Millar. "Biopsychosocial approach to tendinopathy". BMJ Open Sport & Exercise Medicine 8, nr 3 (sierpień 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 i Karen H. Seal. "An Integrated Pain Team Model: Impact on Pain-Related Outcomes and Opioid Misuse in Patients with Chronic Pain". Pain Medicine 21, nr 9 (25.02.2020): 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.
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Ferreira Valente, Maria Alexandra, José Luís Pais Ribeiro i Mark P. Jensen. "Coping, Depression, Anxiety, Self-Efficacy and Social Support: Impact on Adjustment to Chronic Pain". Escritos de Psicología - Psychological Writings 2, nr 3 (1.09.2009): 8–17. http://dx.doi.org/10.24310/espsiescpsi.v2i3.13382.
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Pain is a multidimensional, unique, and private experience. Contemporary biopsychosocial models of chronic pain hypothesize a key role for psychosocial factors as contributing to the experience of and adjustment to chronic pain. The psychosocial factors that have been most often examined as they relate to chronic pain include coping responses, attributions (such as self-efficacy), mood (including depression and anxiety), and social support. Knowledge concerning the relative importance of each of these factors to adjustment is necessary for understanding and developing effective psychosocial interventions. This article reviews the literature concerning the associations between psychosocial factors and adjustment to chronic pain, with a focus on coping, attributions, mood, and social support. Overall, the findings of this research are consistent with biopsychosocial models of chronic pain, and support continued research to help identify the causal relationships among key psychosocial variables and adjustment.
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Purcell, Natalie, Kara Zamora, Carolyn Gibson, Jennifer Tighe, Jamie Chang, Joseph Grasso i Karen H. Seal. "Patient Experiences With Integrated Pain Care: A Qualitative Evaluation of One VA’s Biopsychosocial Approach to Chronic Pain Treatment and Opioid Safety". Global Advances in Health and Medicine 8 (styczeń 2019): 216495611983884. http://dx.doi.org/10.1177/2164956119838845.
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Background Mounting concern about the risks and limited effectiveness of opioid therapy for chronic pain has spurred the implementation of novel integrated biopsychosocial pain care models in health-care systems like the Department of Veterans Affairs (VA). However, little is known about patient experiences with these new care models. Objective We conducted a qualitative study to examine patient experiences with a pain care model currently being disseminated at the VA: interdisciplinary, integrated pain teams (IPTs) embedded in primary care. Method We interviewed 41 veterans who received care from VA’s first IPT to learn how working with the team impacted their pain care and quality of life. We asked about their overall experience with IPT, what worked and did not work for them, and what changes they would recommend to improve IPT care. Results The interviews revealed a wide spectrum of patient experiences and varying perspectives on the extent to which the new model improved their pain and quality of life. Thematic analysis shed light on factors impacting patients’ experiences, including pretreatment goals and expectations as well as attitudes toward opioids and nonpharmacological treatments. Conclusion We discuss the implications of our findings for national efforts to implement biopsychosocial pain care, and we offer recommendations to promote patient-centered implementation.
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Taylor, Lou Ella V., Nancy A. Stotts, Janice Humphreys, Marsha J. Treadwell i Christine Miaskowski. "A Biopsychosocial-Spiritual Model of Chronic Pain in Adults with Sickle Cell Disease". Pain Management Nursing 14, nr 4 (grudzień 2013): 287–301. http://dx.doi.org/10.1016/j.pmn.2011.06.003.
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Atanasova, Nina A. "Three Roles of Narratives in the Treatment of Chronic Pain". Balkan Journal of Philosophy 13, nr 1 (2021): 77–82. http://dx.doi.org/10.5840/bjp20211319.
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In this paper, I discuss the roles narratives play in the diagnostics, treatment, and recovery of chronic pain patients. I show that the successes of this narrative approach to the treatment of chronic pain support the biopsychosocial model of disease. The central example of narrative interventions discussed in the paper is pain neuroscience education. This is an intervention which aims at helping chronic pain patients reconceptualize their pain experiences so as to align them with neuroscientific knowledge of pain. Multiple clinical trials have established the success of these interventions in pain reduction. This shows that neuroscience pain education is in fact an evidence-based approach. I conclude that narrative and evidence-based medicine are compatible.
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Fenton, Bradford W., Scott F. Grey, Krystel Tossone, Michele McCarroll i Vivian E. Von Gruenigen. "Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures". Pain Research and Treatment 2015 (18.08.2015): 1–8. http://dx.doi.org/10.1155/2015/940675.
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Chronic pelvic pain affects multiple aspects of a patient’s physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients’ pain. Based on the 11 PROMIS domains applied to n=613 patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes.
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Bay, Esther H., i Israel Liberzon. "Early Stress Response: A Vulnerability Framework for Functional Impairment Following Mild Traumatic Brain Injury". Research and Theory for Nursing Practice 23, nr 1 (luty 2009): 42–61. http://dx.doi.org/10.1891/1541-6577.23.1.42.
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Nearly 64% of people with mild traumatic brain injury (MTBI) experience prolonged symptoms and functional impairments lasting months or years postinjury. Explanations for delayed recovery have varied and lacked a guiding framework, hindering intervention science. Using theory substruction and adapting McLean and associates’ biopsychosocial model for chronic pain after trauma, we suggest that perceived psychological stress and associated neurobiological responses may predict risk for functional impairment. This model can be tested using a biopsychosocial approach to determine the interplay of psychological stress and neurobiological responses implicated in functional impairments after MTBI. Testing of this model will advance understanding of pathways to postconcussion syndrome.
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Nicosia, Francesca M., Carolyn J. Gibson, Natalie Purcell, Kara Zamora, Jennifer Tighe i Karen H. Seal. "Women Veterans’ Experiences with Integrated, Biopsychosocial Pain Care: A Qualitative Study". Pain Medicine 22, nr 9 (6.02.2021): 1954–61. http://dx.doi.org/10.1093/pm/pnaa481.
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Abstract Objectives Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic pain care and reduce opioid-related risks, but little is known about how well these models address women veterans’ needs. Design Qualitative, interview-based study. Setting San Francisco VA Health Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized chronic pain care emphasizing functional goals and active self-management. Subjects Women with chronic pain who completed ≥3 IPT sessions. Methods Semistructured phone interviews focused on overall experience with IPT, perceived effectiveness of IPT care, pain care preferences, and suggested changes for improving gender-sensitive pain care. We used a rapid approach to qualitative thematic analysis to analyze interviews. Results Fourteen women veterans (mean age 51 years; range 33–67 years) completed interviews. Interviews revealed several factors impacting women veterans’ experiences: 1) an overall preference for receiving both primary and IPT care in gender-specific settings, 2) varying levels of confidence that IPT could adequately address gender-specific pain issues, 3) barriers to participating in pain groups, and 4) barriers to IPT self-management recommendations due to caregiving responsibilities. Conclusions Women veterans reported varied experiences with IPT. Recommendations to improve gender-sensitive pain care include increased provider training; increased knowledge of and sensitivity to women’s health concerns; and improved accommodations for prior trauma, family and work obligations, and geographic barriers. To better meet the needs of women veterans with chronic pain, integrated pain care models must be informed by an understanding of gender-specific needs, challenges, and preferences.
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Cabak, Anna, Agnieszka Rudnicka, Leszek Kulej i Wiesław Tomaszewski. "Biopsychosocial Rehabilitation Programme for Patients with Chronic Back Pain. Pilot Study". Ortopedia Traumatologia Rehabilitacja 19, nr 2 (12.04.2017): 165–74. http://dx.doi.org/10.5604/15093492.1238033.
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Background. In the search for effective and comprehensive therapies of back pain, an increasing emphasis in being placed on the biopsychosocial model and multidimensional support programmes for patients as well the use of modern technologies in this area of medicine. This study aimed to assess a programme of customised ad hoc physiotherapeutic consultations for patients with back pain who had been on the waiting list for rehabilitation treatment for a long time. Material and method. The study group comprised 68 patients of the Rehabilitation Centre Non-Public Health Care Institution who had been waiting for rehabilitation treatment for at least three months. The patients, diagnosed with chronic back pain and aged 40-80 years, were randomly assigned into two groups. The experimental group took part in a programme of three consultations, provided on average once a month. The patients from both groups were assessed after the three-month programme, immediately before the commencement of the prescribed rehabilitation treatment. We evaluated the pain threshold at trigger points of selected muscles using the algometric method (kg/cm 2 ), subjective assessment of pain (VAS), functional limitations (Rolland Morris Disability Questionnaire) and quality of life (36-Item Short Form Health Survey, SF-36). The statistical analysis of the results used non-parametric methods: significance of differences between the groups was evaluated with the Mann–Whitney U test and correlations between the variables were assessed separately for each group using Spearman’s rank order correlation. The significance threshold was accepted at α=0.05. Results. The algometric evaluation of all the muscles revealed significantly lower sensitivity to pain, demonstrated by a higher pain threshold (p<0.0001), in the experimental group. Moreover, this group also included a much smaller percentage of patients with a high level of functional limitations according to the Rolland Morris Disability Questionnaire. The quality of life evaluation revealed that the control group scored poorer in the mental domain (p=0.02). Conclusions. The ad hoc intervention programme for patients referred for rehabilitation due to chronic back pain showed demonstrable beneficial effects with regard to their psychophysical health. Similar programmes should be more readily offered to patients at health care centres and implemented into clinical practice.
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Truchon, Manon. "Determinants of chronic disability related to low back pain: Towards an integrative biopsychosocial model". Disability and Rehabilitation 23, nr 17 (styczeń 2001): 758–67. http://dx.doi.org/10.1080/09638280110061744.
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Hertel, Jay, i Revay O. Corbett. "An Updated Model of Chronic Ankle Instability". Journal of Athletic Training 54, nr 6 (1.06.2019): 572–88. http://dx.doi.org/10.4085/1062-6050-344-18.
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Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.
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Harrison, Lauren E., Joshua W. Pate, Patricia A. Richardson, Kelly Ickmans, Rikard K. Wicksell i Laura E. Simons. "Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain". Journal of Clinical Medicine 8, nr 9 (21.08.2019): 1267. http://dx.doi.org/10.3390/jcm8091267.
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Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has guided our understanding and treatment of pediatric pain. Consequently, many interventions for chronic pain are within the realm of rehabilitation, based on the premise that behavior has a broad and central role in pain management. These treatments are typically delivered by one or more providers in medicine, nursing, psychology, physical therapy, and/or occupational therapy. Current data suggest that multidisciplinary treatment is important, with intensive interdisciplinary pain rehabilitation (IIPT) being effective at reducing disability for patients with high levels of functional disability. The following review describes the current state of the art of rehabilitation approaches to treat persistent pain in children and adolescents. Several emerging areas of interventions are also highlighted to guide future research and clinical practice.
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Mardian, Aram S., Eric R. Hanson, Lisa Villarroel, Anita D. Karnik, John G. Sollenberger, Heather A. Okvat, Amrita Dhanjal-Reddy i Shakaib Rehman. "Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care". Pain Medicine 21, nr 6 (7.01.2020): 1168–80. http://dx.doi.org/10.1093/pm/pnz336.
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Abstract Objective Much of the pain care in the United States is costly and associated with limited benefits and significant harms, representing a crisis of value. We explore the current factors that lead to low-value pain care within the United States and provide an alternate model for pain care, as well as an implementation example for this model that is expected to produce high-value pain care. Methods From the perspective of aiming for high-value care (defined as care that maximizes clinical benefit while minimizing harm and cost), we describe the current evidence practice gap (EPG) for pain care in the United States, which has developed as current clinical care diverges from existing evidence. A discussion of the biomedical, biopsychosocial, and sociopsychobiological (SPB) models of pain care is used to elucidate the origins of the current EPG and the unconscious factors that perpetuate pain care systems despite poor results. Results An interprofessional pain team within the Veterans Health Administration is described as an example of a pain care system that has been designed to deliver high-value pain care and close the EPG by implementing the SPB model. Conclusions Adopting and implementing a sociopsychobiological model may be an effective approach to address the current evidence practice gap and deliver high-value pain care in the United States. The Phoenix VA Health Care System’s Chronic Pain Wellness Center may serve as a template for providing high-value, evidence-based pain care for patients with high-impact chronic pain who also have medical, mental health, and opioid use disorder comorbidities.
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Booker, Staja Q., Lakeshia Cousin i Harleah G. Buck. "“Puttin’ on”: Expectations Versus Family Responses, the Lived Experience of Older African Americans With Chronic Pain". Journal of Family Nursing 25, nr 4 (listopad 2019): 533–56. http://dx.doi.org/10.1177/1074840719884560.
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The lack of family research documenting the changes that occur and the capacity of families to support individuals with chronic pain effectively is a major limitation in the application of the biopsychosocial model of pain. This study investigated the lived experience of older African Americans ( N = 18) with chronic pain and explored their expectations and perceptions of familial support. A descriptive phenomenology framework revealed an existential theme: “puttin’ on,” a phenomenon that potentiates the power of pain to disrupt roles and relationships and discourages the family from meeting the expected needs of older African Americans. We uncovered new information into the actual support mechanisms that are missing or, when present, are not as positive and strong as would be expected in the African American culture, at least in the context of chronic pain management. Interventions should target family-based education, chronic pain destigmatization, and intergenerational empathy in the African American community.
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Vetter, Thomas R., Gerald McGwin, Cynthia L. Bridgewater, Avi Madan-Swain i Lee I. Ascherman. "Validation and Clinical Application of a Biopsychosocial Model of Pain Intensity and Functional Disability in Patients with a Pediatric Chronic Pain Condition Referred to a Subspecialty Clinic". Pain Research and Treatment 2013 (22.10.2013): 1–12. http://dx.doi.org/10.1155/2013/143292.
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Background. Pediatric chronic pain is considered to be a multidimensional construct that includes biological, psychological, and social components. Methods. The 99 enrolled study patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed a series of health-related questionnaires at the time of their initial appointment in a pediatric chronic pain medicine clinic. Results. Significant correlations (, ) were observed between pediatric chronic pain intensity and patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, and parent functional disability. Pediatric chronic pain intensity was significantly associated with patient anxiety (). Significant correlations (, ) were observed between pediatric functional disability and patient chronic pain intensity, patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, parent functional disability, parent anxiety, parent depression, and parent stress. Pediatric functional disability was significantly associated with patient chronic pain intensity (), patient anxiety (), patient pain coping (), and parent functional disability (). Conclusions. These findings provide empirical support of a multidimensional Biobehavioral Model of Pediatric Pain. However, the practical clinical application of the present findings and much of the similar previously published data may be tenuous.
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Finestone, Hillel M., Aziz Alfeeli i William A. Fisher. "Stress-induced Physiologic Changes as a Basis for the Biopsychosocial Model of Chronic Musculoskeletal Pain". Clinical Journal of Pain 24, nr 9 (listopad 2008): 767–75. http://dx.doi.org/10.1097/ajp.0b013e3181790342.
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Saariaho, A., i T. H. Saariaho. "F405 BIOPSYCHOSOCIAL MODELS OF PAIN IN A CHRONIC PAIN PATIENT AND A PAINFUL CONTROL GROUP". European Journal of Pain Supplements 5, S1 (wrzesień 2011): 153. http://dx.doi.org/10.1016/s1754-3207(11)70526-0.
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Camacho, David, Denise Burnette, Maria P. Aranda i Ellen Lukens. "THE ASSOCIATION OF LONELINESS AND CHRONIC CLINICALLY SIGNIFICANT PAIN AMONG AFRICAN AMERICAN AND WHITE OLDER ADULTS". Innovation in Aging 3, Supplement_1 (listopad 2019): S613. http://dx.doi.org/10.1093/geroni/igz038.2281.
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Abstract Loneliness and pain are significant public health problems in later life, yet limited research has examined how these factors interact among racially diverse older adults. Guided by the Biopsychosocial Model of Pain, we used data from Waves 2 and 3 of the National Social Life, Health, and Aging Project to investigate the relationship between loneliness and chronic pain among 1,102 African-American and White adults aged 50 and over. Using logistic regression analyses, our final models considered demographics, physical and mental health, functioning, medication, health behaviors and social factors. Approximately 32% of African Americans and 28% of Whites reported chronic loneliness. Compared to Whites African-Americans were 2.5 times more likely to experience chronic pain. Among White participants, loneliness was not associated with chronic pain; however, the interaction of being African-American and lonely was associated with decreased odds of chronic pain in main and gendered analyses. African American women were 4 times more likely than White women to report chronic pain. Our results address the objectives of the National Pain Strategy (2016) to elucidate the experiences of chronic pain among diverse elders in the US. Future work should seek a deeper understanding of loneliness and chronic pain among African Americans elders and how cultural dynamics may help explain our counter intuitive findings (e.g., “Superwoman Schema”).
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King, Richard, Victoria Robinson, Helene L. Elliott-Button, James A. Watson, Cormac G. Ryan i Denis J. Martin. "Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study". Pain Research and Management 2018 (12.09.2018): 1–10. http://dx.doi.org/10.1155/2018/3745651.
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Pain neurophysiology education (PNE) is an educational intervention for patients with chronic pain. PNE purports to assist patients to reconceptualise their pain away from the biomedical model towards a more biopsychosocial understanding by explaining pain biology. This study aimed to explore the extent, and nature, of patients’ reconceptualisation of their chronic low back pain (CLBP) following PNE. Eleven adults with CLBP underwent semistructured interviews before and three weeks after receiving PNE. Interviews were transcribed verbatim and thematically analysed in a framework approach using four a priori themes identified from our previous research: (1) degrees of reconceptualisation, (2) personal relevance, (3) importance of prior beliefs, and (4) perceived benefit of PNE. We observed varying degrees of reconceptualisation from zero to almost complete, with most participants showing partial reconceptualisation. Personal relevance of the information to participants and their prior beliefs were associated with the degree of benefit they perceived from PNE. Where benefits were found, they manifested as improved understanding, coping, and function. Findings map closely to our previous studies in more disparate chronic pain groups. The phenomenon of reconceptualisation is applicable to CLBP and the sufficiency of the themes from our previous studies increases confidence in the certainty of the findings.
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Toye, Francine, Kate Seers i Karen L. Barker. "Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain". BMJ Open 7, nr 12 (grudzień 2017): e018411. http://dx.doi.org/10.1136/bmjopen-2017-018411.
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ObjectivesWe aimed to explore healthcare professionals’ experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care.DesignQualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals’ experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings.ResultsWe screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high.ConclusionsThis is the first qualitative evidence synthesis of healthcare professionals’ experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.
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Camacho, David, Maria P. Aranda, Denise Burnette i Ellen Lukens. "THE EFFECTS OF CHRONIC PAIN AND LONELINESS ON FUNCTIONING AMONG LATINO AND WHITE OLDER ADULTS". Innovation in Aging 3, Supplement_1 (listopad 2019): S585. http://dx.doi.org/10.1093/geroni/igz038.2169.
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Abstract The detrimental effects of loneliness and chronic pain on functioning in later life are well documented, yet there is little evidence of whether these patterns hold across racially diverse older adults. Guided by the Biopsychosocial Model of Assessment, Prevention, and Treatment of Chronic Pain, we used data from Waves 2 and 3 of the National Social Life, Health, and Aging Project (NSHAP) to examine the additive and interactive effects of loneliness and chronic pain on Elemental and Instrumental Activities of Daily Living (ADLs & IADLs) among a sample of 1046 Latino and White adults aged 50 and over. Using linear regression analyses, our final models (Adjusted R-squares: .316 & .304) included demographic characteristics, physical and mental health, medication, health behaviors and social factors. In this sample, approximately 33% experienced chronic pain, 50% reported at least transitory loneliness and 22% experienced both. Neither loneliness nor chronic pain was independently associated with functioning impairment. However, these two factors in combination were associated with lower scores on ADLs and I-ADLs. In addition, Latinos who reported chronic pain were more likely to report lower scores on ADLs only. Results highlight variations in the detrimental effects of loneliness and chronic pain for white and Latino elders. Findings suggest the need for interventions that address chronic pain and loneliness simultaneously. Future studies should examine how culturally-grounded experiences of loneliness and chronic pain may contribute to worsening of functioning among diverse groups of Latino elders.
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Adams, Nicola. "Psychological, Electromyographic, and Neurochemial Aspects of Chronic Low Back Pain: Can a Biopsychosocial Model Be Confirmed?" Journal of Musculoskeletal Pain 14, nr 2 (styczeń 2006): 33–44. http://dx.doi.org/10.1300/j094v14n02_05.
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Koenig, Harold G., Debra K. Weiner, Bercedis L. Peterson, Keith G. Meador i Francis J. Keefe. "Religious Coping in the Nursing Home: A Biopsychosocial Model". International Journal of Psychiatry in Medicine 27, nr 4 (grudzień 1997): 365–76. http://dx.doi.org/10.2190/m2d6-5ydg-m1dd-a958.
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Objective: To examine psychosocial and physical health correlates of religious coping in medically ill chronically institutionalized older adults. Religious coping is defined as the extent to which persons use religious beliefs and practices to help them to cope. Method: This is a cross-sectional cohort study conducted in a 120 bed VA-affiliated and a 125 bed university-affiliated community-based nursing home in Durham, North Carolina. Participants were 115 chronic care nursing home residents; mean age of the sample was seventy-nine years, 44 percent were women, and 17 percent were African Americans. Subjects were enrolled for a one-month period during which comprehensive psychosocial and health assessments were performed, including evaluation of cognitive function (Mini-Mental State Exam), physical function (Barthel index), severity of medical comorbidity (Cumulative Illness Rating Scale), self-reported physical pain (vertical verbal descriptor scale), depressive symptoms (Geriatric Depression Scale), social support (social network), and religious coping (Religious Coping Index). Results: Over 43 percent of the sample scored in the depressed range of the Geriatric Depression Scale. Almost 60 percent reported they used religion at least to a large extent when coping with their problems; 34 percent said that it was the most important factor that enabled them to cope. Patients who used religion to cope had greater social support ( p = .01), more severe medical illness ( p = .04), and better cognitive functioning ( p = .02). Conclusions: Religious beliefs and practices are frequently used by chronically institutionalized older adults to help them to cope. Religious coping is associated with more severe medical illness, higher social support, and better cognitive functioning.
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Ciucă, Andrada, i Adriana Băban. "Psychological factors and psychosocial interventions for cancer related pain". Romanian Journal of Internal Medicine 55, nr 2 (1.06.2017): 63–68. http://dx.doi.org/10.1515/rjim-2017-0010.
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Abstract The present paper is aimed at briefly presenting psychological factors involved in cancer related pain and what psychosocial interventions are efficient in reducing it. Cancer related pain is a complex experience and the most integrative and recommended approach is the biopsychosocial model. It has been proved that chronic pain is more strongly related to psychological factors than to treatment or illness related factors. Psychological factors influencing pain experience can be intuitively grouped starting with awareness of pain (i.e., attentional factor), then with evaluation of pain (i.e., cognitive factors) which is leading to feelings (i.e., emotional factors), and behaviours (i.e., coping strategies) regarding pain. Psychosocial interventions (i.e., skill based and education based interventions) have strong evidence that is effective in reducing cancer related pain.
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Driscoll, Mary A., Robert R. Edwards, William C. Becker, Ted J. Kaptchuk i Robert D. Kerns. "Psychological Interventions for the Treatment of Chronic Pain in Adults". Psychological Science in the Public Interest 22, nr 2 (wrzesień 2021): 52–95. http://dx.doi.org/10.1177/15291006211008157.
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The high prevalence and societal burden of chronic pain, its undertreatment, and disparities in its management have contributed to the acknowledgment of chronic pain as a serious public-health concern. The concurrent opioid epidemic, and increasing concern about overreliance on opioid therapy despite evidence of limited benefit and serious harms, has heightened attention to this problem. The biopsychosocial model has emerged as the primary conceptual framework for understanding the complex experience of chronic pain and for informing models of care. The prominence of psychological processes as risk and resilience factors in this model has prompted extensive study of psychological treatments designed to alter processes that underlie or significantly contribute to pain, distress, or disability among adults with chronic pain. Cognitive-behavioral therapy is acknowledged to have strong evidence of effectiveness; other psychological approaches, including acceptance and commitment therapy, mindfulness, biofeedback, hypnosis, and emotional-awareness and expression therapy, have also garnered varying degrees of evidence across multiple pain conditions. Mechanistic studies have identified multiple pathways by which these treatments may reduce the intensity and impact of pain. Despite the growing evidence for and appreciation of these approaches, several barriers limit their uptake at the level of organizations, providers, and patients. Innovative methods for delivering psychological interventions and other research, practice, and policy initiatives hold promise for overcoming these barriers. Additional scientific knowledge and practice gaps remain to be addressed to optimize the reach and effectiveness of these interventions, including tailoring to address individual differences, concurrently addressing co-occurring disorders, and incorporating other optimization strategies.
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Santos, Monique Rocha Peixoto dos, Leandro Calazans Nogueira, Ney Armando Meziat-Filho, Rob Oostendorp i Felipe José Jandre dos Reis. "Transcultural adaptation into Portuguese of an instrument for pain evaluation based on the biopsychosocial model". Fisioterapia em Movimento 30, suppl 1 (2017): 183–95. http://dx.doi.org/10.1590/1980-5918.030.s01.ao18.
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Abstract Introduction: Pain is an individual experience influenced by multiple interacting factors. The “biopsychosocial” care model has gained popularity in response to growing research evidence indicating the influence of biological, psychological, and social factors on the pain experience. The implementation of this model is a challenge in the practice of the health professional. Objective: To perform the transcultural adaptation of the SCEBS method into Brazilian Portuguese. Methods: The instrument was translated and applied to 50 healthy subjects and 50 participants with non-specific chronic pain in the spine. The process of cross-cultural adaptation included the following steps: transcultural adaptation, content analysis of the scale, pre-test, revision, back-translation review, cross-cultural adaptation, revised text correction and final report. Results: The translated and adapted 51-item Portuguese version of the SCEBS method produced an instrument called SCEBS-BR. In the assessment by the target population, 50 adult users of the Brazilian Unified Health System answered the questionnaire and showed good understanding of the instrument on the verbal rating scale. Conclusion: The SCEBS-BR was proved to be easily understandable, showing good semantic validation regardless of schooling level or age, and can be considered adequate for clinical use.
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Lee, Sang-Shin. "Psychosomatic Approach to Fibromyalgia Syndrome: Concept, Diagnosis and Treatment". Kosin Medical Journal 36, nr 2 (31.12.2021): 79–99. http://dx.doi.org/10.7180/kmj.2021.36.2.79.
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<p>Fibromyalgia syndrome (FMS) has chronic widespread pain (CWP) as a core symptom and a variety of associated somatic and psychological symptoms such as fatigue, sleep problems, cognitive disturbances, multiple somatic pain, and depression. FMS is the subject of considerable controversy in the realm of nosology, diagnosis, pathophysiology, and treatment. Moreover, the fact that FMS and mental illness are closely associated with each other might intensify the confusion for the distinction between FMS and mental disorders. This narrative literature review aims to provide the concept, diagnosis, and treatment of FMS from the integrative biopsychosocial and psychosomatic perspective. This article first explains the concepts of FMS as a disease entity of biopsychosocial model, and then summarizes the changes of diagnostic criteria over past three decades, differential diagnosis and comorbidity issue focused on mental illnesses. In addition, an overview of treatment of FMS is presented mainly by arranging the recommendations from the international guidelines which have been developed by four official academic associations.</p>
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McMurtry, C. Meghan, Rachel M. Tomlinson i Lara M. Genik. "Cognitive Behavioral Therapy for Anxiety and Fear in Pediatric Pain Contexts". Journal of Cognitive Psychotherapy 31, nr 1 (2017): 41–56. http://dx.doi.org/10.1891/0889-8391.31.1.41.
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Pain is a highly prevalent experience in pediatric medical populations, both in an acute form (e.g., iatrogenic pain from needle procedures) as well as in more chronic forms (e.g., as a result of arthritis, inflammatory bowel disease, or as a disease/disorder in and of itself). Guided by the biopsychosocial model, the overarching objective of this work is to examine cognitive behavioral treatment of anxiety in pain contexts. Specific aims are to (a) provide a brief overview of anxiety in youth with a high fear of needles and those experiencing chronic pain, (b) review the evidence base for cognitive behavioral therapy (CBT) for these populations, (c) outline considerations for implementing CBT-based approaches, and (d) provide two case examples which illustrate the application of CBT in these contexts. Brief concluding remarks include suggestions for future research such as improved screening and treatment of comorbid anxiety in the context of pain.
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Marcus, Kelly Stein, Robert D. Kerns, Barry Rosenfeld i William Breitbart. "HIV/AIDS-related Pain as a Chronic Pain Condition: Implications of a Biopsychosocial Model for Comprehensive Assessment and Effective Management". Pain Medicine 1, nr 3 (wrzesień 2000): 260–73. http://dx.doi.org/10.1046/j.1526-4637.2000.00033.x.
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Anamkath, Nidhi S., Sarah A. Palyo, Sara C. Jacobs, Alain Lartigue, Kathryn Schopmeyer i Irina A. Strigo. "An Interdisciplinary Pain Rehabilitation Program for Veterans with Chronic Pain: Description and Initial Evaluation of Outcomes". Pain Research and Management 2018 (2018): 1–9. http://dx.doi.org/10.1155/2018/3941682.
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Objective. Chronic pain conditions are prominent among Veterans. To leverage the biopsychosocial model of pain and comprehensively serve Veterans with chronic pain, the San Francisco Veterans Affairs Healthcare System has implemented the interdisciplinary pain rehabilitation program (IPRP). This study aims to (1) understand initial changes in treatment outcomes following IPRP, (2) investigate relationships between psychological factors and pain outcomes, and (3) explore whether changes in psychological factors predict changes in pain outcomes. Methods. A retrospective study evaluated relationships between clinical pain outcomes (pain intensity, pain disability, and opioid use) and psychological factors (depressive symptoms, catastrophizing, and “acceptable” level of pain) and changes in these outcomes following treatment. Multiple regression analysis explored whether changes in psychological variables significantly predicted changes in pain disability. Results. Catastrophizing and depressive symptoms were positively related to pain disability, while “acceptable” level of pain was idiosyncratically related to pain intensity. Pain disability and psychological variables showed significant changes in their expected directions. Regression analysis indicated that only changes in depressive symptoms significantly predicted changes in pain disability. Conclusion. Our results are consistent with evidence-based clinical practice guidelines for the management of chronic pain in Veterans. Further investigation of interdisciplinary treatment programs in Veterans is warranted.
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Lotze, Martin, i G. Lorimer Moseley. "Theoretical Considerations for Chronic Pain Rehabilitation". Physical Therapy 95, nr 9 (1.09.2015): 1316–20. http://dx.doi.org/10.2522/ptj.20140581.
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Conventional rehabilitation of patients with chronic pain is often not successful and is frustrating for the treatment team. However, theoretical developments and substantial advances in our understanding of the neurological aspects of chronic pain are changing these experiences. Modern theoretical models of pain consider pain to be a perceptual inference that reflects a “best guess” that protective action is required. This article argues that keen observation and open and respectful clinician-patient and scientist-clinician relationships have been critical for the emergence of effective rehabilitation approaches and will be critical for further improvements. The role in modern pain rehabilitation of reconceptualizing the pain itself—by “Explaining Pain,” careful and intentional observation of the person in pain, and the strategic and constant communication of safety—is emphasized. It also is suggested that better understanding of the neural mechanisms underpinning chronic pain has directly informed the development of new therapeutic approaches, which are being further refined and tested. Conventional pain treatment (where the clinician strives to find the pain-relieving medication or exercise) or pain management (where the clinician helps the patient to manage life despite unabating pain) is being replaced by pain rehabilitation, where a truly biopsychosocial approach allows clinicians to provide patients with the knowledge, understanding, and skills to reduce both their pain and disability. A brief overview is provided of the key aspects of modern pain rehabilitation and the considerations that should lead our interaction with patients with chronic pain.
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Lamper, Cynthia, Ivan P. J. Huijnen, Mariëlle E. A. L. Kroese, Albère J. Köke, Gijs Brouwer, Dirk Ruwaard i Jeanine A. M. C. F. Verbunt. "Exploring the feasibility of a network of organizations for pain rehabilitation: What are the lessons learned?" PLOS ONE 17, nr 9 (15.09.2022): e0273030. http://dx.doi.org/10.1371/journal.pone.0273030.
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Background and aims Integration of care is lacking for chronic musculoskeletal pain patients. Network Pain Rehabilitation Limburg, a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients’ levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability. Methods This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. The network comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase. Results According to health care professionals, guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One mentioned barrier is the stigmatization of chronic pain by the general population. In regular care, approaches are often more biomedical than biopsychosocial, causing patients to resist participating. The current organization of health care acts as a barrier, complicating implementation between and within practices. Health care professionals were enthusiastic about the iterative, bottom-up development. A critical mass of participating organizations is needed for proper implementation. Conclusion Network Pain Rehabilitation Limburg is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine Network Pain Rehabilitation Limburg. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model. Trail registration Registration number: NTR6654 or https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6654.
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Ciubara, Anamaria, Roxana Chirita, Gabriela Paduraru, Dania Andreea Radu, Claudia Adriana Olaru, Ilinca Untu i Lucian Stefan Burlea. "The psychosocial impact of chronic abdominal pain in functional gastrointestinal disorders for both children and adolescents – clinical and therapeutic approaches". Romanian Journal of Pediatrics 63, nr 3 (30.09.2014): 229–32. http://dx.doi.org/10.37897/rjp.2014.3.1.
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Both functional abdominal pain and irritable bowel syndrome are common causes of chronic abdominal pain in children and adolescents. Addressing these nosological entities is done according to the biopsychosocial model of functional gastrointestinal disorders, given their effect on quality of life and psychosocial status thereof. The cognitive-behavioral therapy, family psychotherapy, relaxation techniques or hypnotherapy have proved effective in achieving better coping mechanisms in alleviating psychological and somatic symptoms. However, antidepressant medication including selective serotonin reuptake inhibitors and tricyclic antidepressants, improve psychiatric symptomatology, especially depressive mood due to gastrointestinal illness, but also digestive symptoms due to mechanisms of action that depend on complex neurotransmitters.
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Moreno-Ligero, Marta, Jose A. Moral-Munoz, Inmaculada Failde i María Dueñas. "Physical activity levels in adults with chronic low back pain: A national survey in the general Spanish population". Journal of Rehabilitation Medicine 55 (20.01.2023): jrm00366. http://dx.doi.org/10.2340/jrm.v55.4352.
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Objective: To identify and compare physical activity levels in the Spanish population with chronic low back pain and their associated factors.Design: Cross-sectional national study.Subjects: A total of 3,220 adults with chronic low back pain from the 2017 Spanish National Health Survey.Methods: Three groups were defined according to physical activity level (low, moderate, and high) assessed with the International Physical Activity Questionnaire. Descriptive analysis and an ordinal regression model were performed.Results: Thirty percent of the subjects were classed as doing a low level of physical activity, 53% moderate, and 17% high. Females predominated in the low and moderate groups, and the subjects in the high group were younger. Subjects in the low group reported more use of pain-relief, more severe-extreme pain, more functional limitations, and worse quality of life and mental health. Factors more likely to be associated with higher levels of physical activity were: being male, normal body mass index or overweight, better health status, less pain, less physical and cognitive limitations, and more social support.Conclusion: Different aspects of the biopsychosocial framework were associated with the different levels of physical activity in subjects with chronic low back pain. These findings should be taken into consideration in order to establish suitable public health strategies. LAY ABSTRACTPhysical activity benefits subjects with chronic pain, although its performance depends on various factors. This study analysed 3,220 adults with chronic low back pain from the 2017 Spanish National Health Survey, in order to identify and compare levels of physical activity (International Physical Activity Questionnaire) and their associated factors. Thirty percent of subjects were classed as doing low levels of physical activity, 53% moderate, and 17% high. Females predominated in the low and moderate level groups, and subjects with a high level of physical activity were younger. Subjects in the low level of physical activity group reported more consumption of pain-relief, more severe-extreme pain, more functional limitations, and worse quality of life and mental health. Factors associated with more physical activity were being male, normal body mass index (BMI) or overweight, better health status, less pain, less physical and cognitive limitations, and more social support. In conclusion, different biopsychosocial aspects were associated with the different levels of physical activity in subjects with chronic low back pain, and this information should be taken into consideration in order to establish suitable public health strategies.
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Martins, José Alves. "Socioanthropological contributions to physical therapy in chronic back pain". Fisioterapia em Movimento 30, suppl 1 (2017): 101–9. http://dx.doi.org/10.1590/1980-5918.030.s01.ao10.
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Abstract Introduction: The high prevalence of chronic back pain is related to biopsychosocial factors. In this respect, pain is understood as a multifactorial phenomenon made unique by the previous ideas of each individual. Thus, the present study aimed Objective: To understand the experience of chronic back pain and the effectiveness of physiotherapeutic approaches to support new care strategies. Methods: In terms of qualitative research, a comprehensive approach was adopted using the theoretical and conceptual framework developed in the fields of anthropology and health. The sample consisted of 13 women residing in the municipality of Várzea Grande, Mato Grosso state (MT), Brazil, over 40 years old, homemakers, diagnosed with chronic back pain, treated at the Univag clinical school and who had completed physiotherapy more than six months previously. Results: Data analysis indicated that more traditional forms of outpatient physiotherapy prompted a significant improvement in chronic back pain. However, because the condition is chronic, all patients relapsed and their pain and dysfunctional conditions returned. Conclusion: Multiple factors influence the experience of chronic back pain and the constant self-management required forms a circular relationship between objective and subjective elements. On the other hand, by disregarding these elements, physiotherapeutic approaches provide predominantly technical and scientific care far removed from the experience of the affected subject. In this respect, the chronic condition requires long-term care, whereby the focus should shift from the pursuit of a cure to the care model.
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Ferlito, Rosario, Chiara Blatti, Ludovico Lucenti, Umberto Boscarino, Marco Sapienza, Vito Pavone i Gianluca Testa. "Pain Education in the Management of Patients with Chronic Low Back Pain: A Systematic Review". Journal of Functional Morphology and Kinesiology 7, nr 4 (26.09.2022): 74. http://dx.doi.org/10.3390/jfmk7040074.
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New prospective of chronic low back pain (CLBP) management based on the biopsychosocial model suggests the use of pain education, or neurophysiological pain education, to modify erroneous conceptions of disease and pain, often influenced by fear, anxiety and negative attitudes. The aim of the study is to highlight the evidence on the outcomes of a pain education-oriented approach for the management of CLBP. The search was conducted on the Pubmed, Scopus, Pedro and Cochrane Library databases, leading to 2673 results until September 2021. In total, 13 articles published in the last 10 years were selected as eligible. A total of 6 out of 13 studies support a significant reduction in symptoms in the medium term. Disability is investigated in only 11 of the selected studies, but 7 studies support a clear reduction in the medium-term disability index. It is difficult to assess the effectiveness of the treatments of pain education in patients affected by CLBP, due to the multimodality and heterogeneity of the treatments administered to the experimental group. In general, methods based on pain education or on cognitive-behavioral approaches, in association with physical therapy, appear to be superior to physiotherapeutic interventions alone in the medium term.
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Iddon, Joanne E., Peter J. Taylor, Jen Unwin i Joanne M. Dickson. "The role of positive goal engagement in increased mental well-being among individuals with chronic non-cancer pain". British Journal of Pain 13, nr 4 (18.01.2019): 230–38. http://dx.doi.org/10.1177/2049463718824857.
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Individuals with chronic pain commonly report significant functional impairment and reduced quality of life. Despite this, little is known about psychological processes and mechanisms underpinning enhancements in well-being within this population. The study aimed to investigate whether (1) increased levels of pain intensity and interference were associated with lower levels of mental well-being, (2) increased positive goal engagement was associated with higher levels of mental well-being and (3) whether the relationships between pain characteristics and mental well-being were mediated by increased positive goal engagement. A total of 586 individuals with chronic pain participated in the cross-sectional, online study. Participants completed self-report measures to assess pain intensity and interference, mental well-being and goal motivation variables. Results showed that pain interference and positive goal engagement were associated with mental well-being. Moreover, the relationship between pain interference and mental well-being was partially mediated by positive goal engagement. The results provide tentative evidence for the protective role of positive goal engagement in enabling individuals with chronic pain to maintain a sense of mental well-being. The study develops the biopsychosocial model of chronic pain by examining the roles and relationships of relevant yet previously unexplored psychological constructs. The promotion of mental well-being through the enhancement of positive goal engagement is discussed, offering a platform for further research and clinical interventions.
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Arsentev, Vadim G., Ekaterina A. Voloshina, Elena V. Vyutrih, Yuriy S. Sergeev i Nikolai P. Shabalov. "Constitutional features of connective tissue as a risk factor of chronic pain in adolescents". Pediatrician (St. Petersburg) 7, nr 3 (15.09.2016): 63–69. http://dx.doi.org/10.17816/ped7363-69.
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A total of 504 male adolescents aged 14-18, cadet schools students were examined to identify primary head pain and functional abdominal pain. A 4-stage-blind clinical laboratory and case-control psychological examination, in which are formed two groups: basic - 90 boys with primary head pain and functional abdominal pain, and 93 healthy children (control group). Total number of teens with headaches was 76 (48 isolated headaches and 28 - headaches in conjunction with abdominal pain). The number of cadets with abdominal pain was 42, 14 was manifested monosemeiotic and 28 - in conjunction with headaches. Complex research revealed pathogenetic common primary headaches and functional abdominal pain, to identify risk factors for their development. The analysis of the results of complex examination adolescents univariate statistics significant association features of the connective tissue with the presence of primary headache, especially in combination with functional abdominal pain. Obtained significant differences in many biological, psychological and social characteristics. This fact indicates eligibility review genesis of functional disorders with painful symptoms in adolescents from the perspective of the biopsychosocial model. The present results indicate the importance of the state of the connective tissue as an essential component of the formation of predisposition to chronic pain. Other predictors of pain were advancing sexual development, emotional instability, additional sports classes.
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Rabbitts, Jennifer A., Tonya M. Palermo i Emily A. Lang. "A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents". Journal of Pain Research Volume 13 (listopad 2020): 3071–80. http://dx.doi.org/10.2147/jpr.s239320.
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Talo, S., U. Rytökoski, P. Puukka, E. Alanen, L. Niitsuo, A. Hämäläinen, M. Vaara i M. Tuomaala. "An empirical investigation of the ‘Biopsychosocial Disease Consequence Model’: Psychological impairment, disability and handicap in chronic pain patients". Disability and Rehabilitation 17, nr 6 (styczeń 1995): 281–92. http://dx.doi.org/10.3109/09638289509166648.
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Nogueira Carrer, Helen Cristina, Gisele Garcia Zanca i Melina Nevoeiro Haik. "Clinical Assessment of Chronic Musculoskeletal Pain—A Framework Proposal Based on a Narrative Review of the Literature". Diagnostics 13, nr 1 (26.12.2022): 62. http://dx.doi.org/10.3390/diagnostics13010062.
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The assessment of chronic musculoskeletal pain (CMP) is a challenge shared by several health professionals. Fragmented or incomplete assessment can cause deleterious consequences for the patient’s function. The objective of this paper was to propose a framework for clinical assessment of CMP based on the current literature and following the conceptual model of the International Classification of Functioning and Health (ICF). We propose that the ICF rationale may help to guide the processes, acting as a moderator of the clinical assessment, since it changes the perspective used to obtain and interpret findings during anamnesis and physical examination. Additionally, updated specific knowledge about pain, including that of pain domains and mechanisms, along with effective patient–clinician communication may act as a mediator of CMP assessment. We conduct the readers through the steps of the clinical assessment of CMP using both the proposed moderator and mediators and present a clinical example of application. We suggest that the proposed framework may help clinicians to implement a CMP assessment based on the biopsychosocial model using a critical and updated rationale, potentially improving assessment outcomes, i.e., clinical diagnosis.