Dear Colleagues,

Chronic pain has significant negative effects on functionality and quality of life. Chronic pain remains a major health problem and socio-economic burden given the high prevalence rates (i.e., between 30% and 51% of adults [1–3] and 56% of elderly people [1]). Multi-modal interventions covering the biopsychosocial components of pain are the gold-standard treatment for chronic pain [4–6]. In a patient-centered approach, all influencing biological, psychological and interpersonal factors should be taken into account [7]. The importance of including self-management strategies (i.e., the individual's ability to manage the symptoms, treatment, physical and psychological consequences and lifestyle changes inherent to living with a chronic condition) has been emphasized [8,9]. Self-management approaches in combination with behavioral changes (e.g., an active lifestyle) have positive effects on pain and function in patients with chronic conditions [10–13]. However, despite implementation strategies, chronic pain management remains guideline-discordant, characterized by the overuse of medical imaging and medication [14–16], advice to restrict work and activities [17] and insufficient attention paid to psychosocial risk factors [18,19]. An interesting option is the use of electronic health (eHealth) programs, as these can deliver fast and tailored information to individuals in a cost-effective way. Several well-designed clinical trials have already shown beneficial effects of eHealth programs for the management of chronic pain [11,20].

References

1. Jackson, T.; Thomas, S.; Stabile, V.; Han, X.; Shotwell, M.; McQueen, K. Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2015, 385 (Suppl. 2), S10. https://doi.org/10.1016/s0140-6736(15)60805-4.
2. Fayaz, A.; Croft, P.; Langford, R.M.; Donaldson, L.J.; Jones, G.T. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open 2016, 6, e010364. https://doi.org/10.1136/bmjopen-2015-010364.
3. Cohen, S.P.; Vase, L.; Hooten, W.M. Chronic pain: an update on burden, best practices, and new advances. Lancet 2021, 397, 2082–2097. https://doi.org/10.1016/s0140-6736(21)00393-7.
4. Pedersen, M.B.; Thinggaard, P.; Geenen, R.; Rasmussen, M.U.; De Wit, M.; March, L.; Mease, P.; Choy, E.; Conaghan, P.G.; Simon, L.; et al. Biopsychosocial Rehabilitation for Inflammatory Arthritis and Osteoarthritis Patients: A Systematic Review and Meta‐Analysis of Randomized Trials. Arthritis Care Res. 2021. https://doi.org/10.1002/acr.24816.
5. Kamper, S.J.; Apeldoorn, A.T.; Chiarotto, A.; Smeets, R.J.E.M.; Ostelo, R.W.J.G.; Guzman, J.; van Tulder, M.W. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015, 350, h444–h444. https://doi.org/10.1136/bmj.h444.
6. Elbers, S.; Wittink, H.; Konings, S.; Kaiser, U.; Kleijnen, J.; Pool, J.; Köke, A.; Smeets, R. Longitudinal outcome evaluations of Interdisciplinary Multimodal Pain Treatment programmes for patients with chronic primary musculoskeletal pain: A systematic review and meta‐analysis. J. Pain 2022, 26, 310–335. https://doi.org/10.1002/ejp.1875.
7. Geenen, R.; Overman, C.L.; Christensen, R.; Åsenlöf, P.; Capela, S.; Huisinga, K.L.; Husebø, M.E.P.; Köke, A.J.A.; Paskins, Z.; Pitsillidou, I.A.; et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Dis. 2018, 77, 797–807. https://doi.org/10.1136/annrheumdis-2017-212662.
8. Carnes, D.; Homer, K.E.; Miles, C.L.; Pincus, T.; Underwood, M.; Rahman, A.; Taylor, S.J. Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: A systematic literature review. Pain 2012, 28, 344–354. https://doi.org/10.1097/ajp.0b013e31822ed2f3.
9. Nicholas, M.K.; Asghari, A.; Blyth, F.M.; Wood, B.M.; Murray, R.; McCabe, R.; Brnabic, A.; Beeston, L.; Corbett, M.; Sherrington, C.; et al. Long-term outcomes from training in self-management of chronic pain in an elderly population: a randomized controlled trial. Pain 2017, 158, 86–95. https://doi.org/10.1097/j.pain.0000000000000729.
10. Miller, J.; MacDermid, J.C.; Walton, D.M.; Richardson, J. Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial. Med. Rehabilitation 2020, 101, 750–761. https://doi.org/10.1016/j.apmr.2019.12.016.
11. Smith, J.; Faux, S.G.; Gardner, T.; Hobbs, M.J.; A James, M.; E Joubert, A.; Kladnitski, N.; Newby, J.M.; Schultz, R.; Shiner, C.T.; et al. Reboot Online: A Randomized Controlled Trial Comparing an Online Multidisciplinary Pain Management Program with Usual Care for Chronic Pain. Pain Med. 2019, 20, 2385–2396. https://doi.org/10.1093/pm/pnz208.
12. Manning, V.L.; Hurley, M.V.; Scott, D.L.; Coker, B.; Choy, E.; Bearne, L.M. Education, Self-Management, and Upper Extremity Exercise Training in People With Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Care Res. 2014, 66, 217–227. https://doi.org/10.1002/acr.22102.
13. Nicholas, M.K.; Asghari, A.; Blyth, F.M.; Wood, B.M.; Murray, R.; McCabe, R.; Brnabic, A.; Beeston, L.; Corbett, M.; Sherrington, C.; et al. Self-management intervention for chronic pain in older adults: A randomised controlled trial. Pain 2013, 154, 824–835. https://doi.org/10.1016/j.pain.2013.02.009.
14. Mafi, J.N.; McCarthy, E.P.; Davis, R.B.; Landon, B.E. Worsening Trends in the Management and Treatment of Back Pain. JAMA Intern. Med. 2013, 173, 1573–1581. https://doi.org/10.1001/jamainternmed.2013.8992.
15. Webster, B.S.; Bauer, A.Z.; Choi, Y.; Cifuentes, M.; Pransky, G.S. Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work-Related, Disabling Low Back Pain. Spine 2013, 38, 1939–1946. https://doi.org/10.1097/brs.0b013e3182a42eb6.
16. Deyo, R.A.; Mirza, S.K.; Turner, J.A.; Martin, B.I. Overtreating chronic back pain: Time to back off?  Board Fam. Med. 2009, 22, 62–68. https://doi.org/10.3122/jabfm.2009.01.080102.
17. Darlow, B.; Fullen, B.; Dean, S.; Hurley, D.; Baxter, G.; Dowell, A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review. Pain 2012, 16, 3–17. https://doi.org/10.1016/j.ejpain.2011.06.006.
18. Roussel, N.A.; Neels, H.; Kuppens, K.; Leysen, M.; Kerckhofs, E.; Nijs, J.; Beetsma, A.J.; Van Wilgen, C.P. History taking by physiotherapists with low back pain patients: are illness perceptions addressed properly? Disability Rehabilitation 2016, 38, 1268–1279. https://doi.org/10.3109/09638288.2015.1077530.
19. Shaw, W.S.; Pransky, G.; Winters, T.; Tveito, T.H.; Larson, S.M.; Roter, D.L. Does the presence of psychosocial “yellow flags” alter patient-provider communication for work-related, acute low back pain? Environ. Med. 2009, 51, 1032–1040. https://doi.org/10.1097/jom.0b013e3181b2f539.
20. Ruehlman, L.S.; Karoly, P.; Enders, C. A randomized controlled evaluation of an online chronic pain self management program. Pain 2012, 153, 319–330. https://doi.org/10.1016/j.pain.2011.10.025.

Dr. Frédéric Telliez
Dr. Nathalie Roussel
Guest Editors

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• chronic pain
• biopsychosocial
• management
• quality of life
• eHealth