Chronic Pain: Diagnosis and Conservative Management/Treatment Strategies

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Pain Management".

Deadline for manuscript submissions: closed (1 April 2024) | Viewed by 7776

Special Issue Editor


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Guest Editor
Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), 122 43 Athens, Greece
Interests: evidence-based physiotherapy practice; prevention; neuromusculoskeletal pathologies; occupational health; physical activity; exercise; low back pain
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Special Issue Information

Dear Colleagues,

Chronic pain is defined as pain that persists or recurs for more than 3 months. Chronic pain can be associated with a 'primary' pathology or 'secondary to an underlying disease'. It is a complex condition experienced in a significant number of neuromusculoskeletal pathologies, disorders of the immune system, and metabolic diseases. Due to its multidimensional characteristics and interference, it is considered one of the global health priorities. Understanding the critical interactions between the impairment level, the pain experience, the associated disability recorded, the epigenetic mechanisms involved in its regulation, and patients' psychosocial state is a prerequisite for developing effective conservative management and treatment plans for a significant part of chronic pain conditions.

Therefore, several challenges arise in the management process of chronic pain conditions. Updating and refining the multidimensional diagnostic criteria in an array of chronic pain conditions is essential for providing more targeted conservative management/treatment strategies alone or in combination with more invasive medical interventions. This Special Issue focuses on presenting the latest research developments related to conservative methods available in the assessment and management of chronic pain conditions. Within the remit of this Special Issue, different interdisciplinary approaches involving pain neuroscience education, exercise and associated methods for its optimal delivery, manual therapy techniques, electrophysical modalities, mind–body interventions, psychologically based approaches, and ergonomic and load management programs can be included. Furthermore, these treatments may be provided under different therapeutic environments (work-based, clinic-based, and under telemonitoring sessions).

The latest research developments and findings in the above areas are welcome. Therefore, we invite you to contribute original research articles and reviews of the literature in this Special Issue of Healthcare (PubMed indexed ISSN 2227-9032), aiming to attract high-quality research papers on the etiology, assessment, conservative treatment, and prevention in a variety of chronic pain pathologies. 

Dr. George A. Koumantakis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pain chronicity
  • musculoskeletal disorders
  • pain classification
  • treatment-based classification
  • central sensitization
  • nociplastic pain
  • neuropathic pain
  • imaging
  • functional neuroimaging
  • biopsychosocial assessment
  • pain management
  • cognitive-behavioral therapy
  • conservative treatment
  • neuro-motor control
  • proprioception
  • manual therapy
  • exercise
  • fascia
  • blood-flow restriction
  • mirror therapy
  • mental imagery
  • pain desenstization
  • graded exposure
  • graded activity
  • progressive loading
  • electrophysical modalities

Published Papers (5 papers)

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Research

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15 pages, 666 KiB  
Article
Specific Neurodynamic Exercises on Pain and Disability in Old Women with Chronic Mechanical Neck Pain: A Randomized Controlled Trial
by Luis Polo-Ferrero, David Canchal-Crespo, Susana Sáez-Gutiérrez, Arturo Dávila-Marcos, Ana Silvia Puente-González and Roberto Méndez-Sánchez
Healthcare 2024, 12(1), 20; https://doi.org/10.3390/healthcare12010020 (registering DOI) - 21 Dec 2023
Viewed by 1224
Abstract
Neurodynamic exercise is a specific type of exercise used as a neural treatment that focuses on restoring altered homeostasis in the neuroimmune system by mobilising the nervous system and other structures. A prospective, randomized clinical trial was performed to evaluate the effect of [...] Read more.
Neurodynamic exercise is a specific type of exercise used as a neural treatment that focuses on restoring altered homeostasis in the neuroimmune system by mobilising the nervous system and other structures. A prospective, randomized clinical trial was performed to evaluate the effect of neurodynamic exercises on disability and neck pain in elderly women over four weeks. Participants were randomized into two groups: a neurodynamic (NM) group (n = 28) and a non-specific exercise (NSE) group (n = 28). Inclusion criteria were women over 65 years of age who subjectively admitted to having mechanical neck pain for more than six months. Results showed that specific neurodynamic exercises can improve pain and disability in older women with chronic mechanical neck pain. Improvements were observed in all variables (p < 0.05). Significant between-group differences in favour of the NM group were only found for neck pressure pain thresholds and both tibialis anterior muscles. Larger effect sizes were obtained in favour of the NM group, especially for pain, disability, neck extension and inclination and pressure pain thresholds. Neurodynamic exercises have been shown to be more clinically relevant in disability and neck pain in older women. Full article
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15 pages, 292 KiB  
Article
Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ-GR) in Patients with Chronic Shoulder Pain
by George A. Koumantakis, Emmanouil Sifakis, Panagiotis Stathis, Spyridon Gigourtakis, Petros I. Tatsios, Eleftherios Paraskevopoulos, Maria Moutzouri and Sotiria Vrouva
Healthcare 2023, 11(18), 2512; https://doi.org/10.3390/healthcare11182512 - 11 Sep 2023
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Abstract
Shoulder pain is one of the most common musculoskeletal pathologies. The association of shoulder pain with impaired proprioception and bodily self-awareness called for the cross-cultural adaptation of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) in Greek. The FreSHAQ is a relatively new self-assessment 9-item [...] Read more.
Shoulder pain is one of the most common musculoskeletal pathologies. The association of shoulder pain with impaired proprioception and bodily self-awareness called for the cross-cultural adaptation of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) in Greek. The FreSHAQ is a relatively new self-assessment 9-item scale for impaired somatic awareness in patients with shoulder pain. The study included 100 participants (54 women) between 20 and 80 years old, with chronic shoulder pain (>3 months duration), able to comprehend and speak Greek, and recruited from three private physical therapy practices. The cross-cultural adaptation process was followed to develop the Greek version of the questionnaire (FreSHAQ-GR). Further testing for construct validity via exploratory factor analysis and correlational analysis with the Shoulder Pain and Disability Index (SPADI), the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH), the pain catastrophizing scale (PCS), a pain intensity visual analog scale (PI-VAS) in the last week, and the demographic characteristics followed. Test–retest reliability of the FreSHAQ-GR in a sub-sample of patients (n = 25) was tested upon repeated completion of the scale after a week and examined with the intraclass correlation coefficient (ICC2,1), the standard error of the measurement (SEM), and the minimum detectable change (MDC) indices. The internal consistency of the scale was also assessed. The factor analysis revealed that the scale comprised one factor relevant to shoulder awareness but with fewer items (first 6 items) than the original FreSHAQ. Additionally, the FreSHAQ-GR (both versions) demonstrated statistically significant correlations (Spearman’s r) with participants’ age (r = −0.31/−0.29, p < 0.002), the PI-VAS (r = 0.54/0.52, p < 0.001), the SPADI total score and both of its subscales (r = 0.39–0.45/0.34–0.39, p < 0.001), the QuickDASH (r = 0.37/0.34, p < 0.001), and the PCS (r = 0.50/0.40, p < 0.001). The questionnaire’s internal consistency (Cronbach’s α/McDonald’s ω) was 0.833/0.827 for the 9-item and 0.871/0.867 for the 6-item FreSHAQ-GR. Test–retest reliability was excellent for both versions of the FreSHAQ-GR (ICC2,1(95% CI) = 0.97/0.98 (0.91–0.99/0.94–0.99), and with a low error margin (SEM = 1.31/0.94 and MDC95% = 3.63/2.61). Therefore, the FreSHAQ-GR (6-item version) possesses very good measurement properties and can be administered to Greek-speaking patients with chronic shoulder pain. Full article
14 pages, 474 KiB  
Article
Two Puzzles, a Tour Guide, and a Teacher: The First Cohorts’ Lived Experience of Participating in the MClSc Interprofessional Pain Management Program
by Zoe A. Leyland, David M. Walton and Elizabeth Anne Kinsella
Healthcare 2023, 11(10), 1397; https://doi.org/10.3390/healthcare11101397 - 11 May 2023
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Abstract
(1) Background: The Master of Clinical Science program (MClSc) in Advanced Healthcare Practice at (University) introduced a new “Interprofessional Pain Management” (IPM) field in September 2019. The purpose of this study is to inquire into the following research question: What are MClSc Interprofessional [...] Read more.
(1) Background: The Master of Clinical Science program (MClSc) in Advanced Healthcare Practice at (University) introduced a new “Interprofessional Pain Management” (IPM) field in September 2019. The purpose of this study is to inquire into the following research question: What are MClSc Interprofessional Pain Management students’ lived experiences of participating in pain management education? (2) This study followed an interpretivist research design. The text that was considered central to descriptions of the lived experience of participating in the IPM program was highlighted and organized into a spreadsheet and then sorted into themes. (3) Results: Five themes in regard to the lived experiences of participating in the first cohort of the MClSc IPM program were identified: Reflection on Stagnation in Professional Disciplines; Meaning Making Through Dialogue with Like-Minded Learners; Challenging Ideas and Critical Thinking at Play; Interprofessionalism as Part of Ideal Practice; and Becoming a Competent Person-Centred Partner in Pain Care. (4) Conclusions: This program offers a unique approach to learning while creating an online platform to work, collaborate, and challenge like-minded experts in the field of pain. In doing this research, we hope that more practitioners will work towards the goal of becoming competent, person-centered pain care providers. Full article
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Review

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19 pages, 611 KiB  
Review
Efficacy of Photobiomodulation Therapy in the Treatment of Pain and Inflammation: A Literature Review
by Ana González-Muñoz, María Cuevas-Cervera, José Javier Pérez-Montilla, Daniel Aguilar-Núñez, Dina Hamed-Hamed, María Aguilar-García, Leo Pruimboom and Santiago Navarro-Ledesma
Healthcare 2023, 11(7), 938; https://doi.org/10.3390/healthcare11070938 - 24 Mar 2023
Cited by 11 | Viewed by 2734
Abstract
The main objective of this literature review was to analyze the efficacy of (PBM) therapy application on subjects with chronic pain and inflammation, and furthermore, to evaluate the methodological quality of the collected literature. The search was conducted using five databases: PubMed, ProQuest, [...] Read more.
The main objective of this literature review was to analyze the efficacy of (PBM) therapy application on subjects with chronic pain and inflammation, and furthermore, to evaluate the methodological quality of the collected literature. The search was conducted using five databases: PubMed, ProQuest, Scopus, Web of Science, and PEDro. The keywords “low level laser therapy”, “chronic pain”, and “inflammation” provided the selection of RCTs that were published within the last 5 years, conducted in humans, and written in English. The PEDro Internal Validity Scale (IVS) checklist was used to evaluate the risk of bias in the included studies. A total of 11 articles were selected, all of them RCTs. Of the articles, five showed that PBM positively influences chronic pain, while another showed the same but only in the short term. In two other articles, the patient’s inflammation improved markedly. In one article there was no improvement in chronic pain and in another, there was no improvement in inflammation. Four articles demonstrated that PBM is beneficial in acute pain. Furthermore, six studies were given an “excellent” score and the remaining five a “good” score based on the IVS. Photobiomodulation has beneficial effects on chronic pain and inflammation, although more research needs to be completed in this line for this to be clarified as the existence of RCTs on this subject is limited. Full article
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Other

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17 pages, 2873 KiB  
Systematic Review
Effectiveness of Self-Care Education for Chronic Neck Pain: A Systematic Review and Meta-Analysis
by Geraldine Valenza-Peña, Javier Martín-Núñez, Alejandro Heredia-Ciuró, Alba Navas-Otero, Laura López-López, Marie Carmen Valenza and Irene Cabrera-Martos
Healthcare 2023, 11(24), 3161; https://doi.org/10.3390/healthcare11243161 - 13 Dec 2023
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Abstract
Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs [...] Read more.
Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions. Full article
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