UNASSIGNED: Until recently, treatments for chronic pain commonly relied on in-person interventions, and despite more hybrid care options today, capacity for delivery remains challenged. Digital programs focusing on the psychosocial aspects of pain may provide low-barrier alternatives.
UNASSIGNED: Through a randomized controlled trial, we investigated the effectiveness of a multimodal mobile application.
UNASSIGNED: Participants (n = 198; 82% women, mean age = 46.7 [13.1] years; mean pain duration 13.6 [11.2] years) with nonmalignant chronic pain were randomized to either a 6-week intervention (n = 98) or a wait-listed usual care group (n = 100). The intervention involved regular engagement with a user-guided mobile application (Curable Inc.) informed by the biopsychosocial model of pain that included pain education, meditation, cognitive behavioral therapy, and expressive writing. The co-primary outcomes were pain severity and interference at 6 weeks.
UNASSIGNED: We observed significant improvements in the intervention group compared to the control group with estimated changes of -0.67 (95% confidence interval [CI] -1.04 to -0.29, P < .001, d = 0.43) and -0.60 (95% CI -1.18 to -0.03, P = .04, d = 0.27) for pain severity and interference, respectively. There were significant improvements across secondary outcomes (Patient-Reported Outcome Measurement Information System pain interference; pain catastrophizing; anxiety, depression; stress). Frequency of app use was correlated with improved pain interference (P < .001) and pain catastrophizing (P = 0.018), and changes from baseline persisted in the intervention group at 12 weeks (P < .05).
UNASSIGNED: A short-term mobile app intervention resulted in significant improvements across physical and mental health outcomes compared to wait-listed usual care.
Contexte : Jusqu\'à récemment, les traitements pour la douleur chronique se faisaient principalement en personne. Bien que de plus en plus d\'options de soins hybrides soient désormais disponibles, la capacité à fournir ces soins demeure un défi. Les programmes numériques qui se concentrent sur les aspects psychosociaux de la douleur peuvent offrir des solutions de rechange présentant peu de barrières.Objectifs : Dans le cadre d\'un essai contrôlé randomisé, nous avons étudié l\'efficacité d\'une application mobile multimodale.Méthodes : Les participants (n = 198 ; 82 % de femmes, âge moyen = 46,7 [13,1] ans; durée moyenne de la douleur 13,6 [11,2] ans) souffrant de douleur chronique non cancéreuse ont été répartis au hasard entre une intervention de six semaines (n = 98) et un groupe de soins habituels sur liste d\'attente (n = 100). L\'intervention consistait en l’utilisation régulière d’une application mobile guidée par l\'utilisateur, basée sur le modèle biopsychosocial de la douleur comprenant l\'éducation à la douleur, la méditation, la thérapie cognitivo-comportementale et l\'écriture expressive. Les résultats coprimaires étaient l\'intensité de la douleur et l\'interférence à six semaines.Résultats : Nous avons observé des améliorations significatives dans le groupe d\'intervention par rapport au groupe témoin, avec des changements estimés de -0,67 (intervalle de confiance à 95 % [IC] -1,04 à -0,29, P < 0,001, d = 0,43) et -0,60 (IC 95 % -1,18 à -0,03, P = 0,04, d = 0,27) pour l\'intensité de la douleur et l\'interférence, respectivement. Des améliorations significatives ont été observées pour les résultats secondaires (interférence de la douleur selon le système d’information sur les mesures de résultats rapportés par les patients; catastrophisation de la douleur; anxiété; dépression et stress). La fréquence d\'utilisation de l\'application était corrélée à une amélioration de l\'interférence de la douleur (P < 0,001) et de la catastrophisation de la douleur (P = 0,018). De plus, les changements par rapport à l\'état initial ont persisté dans le groupe d\'intervention après 12 semaines (P < 0,05).Conclusions : Une intervention à court terme au moyen d\'une application mobile a permis d\'améliorer de manière significative les résultats en matière de santé physique et mentale comparativement aux soins habituels sur liste d\'attente.

UNASSIGNED: This paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage.
UNASSIGNED: Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0).
UNASSIGNED: The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain.
UNASSIGNED: This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.
The exploration of patients’ pain perception may provide an opportunity to better develop and design culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The rehabilitation process should incorporate a balanced biopsychosocial approach, addressing both physical and psychosocial elements of pain, to provide more effective care and outcomes for Lebanese patients who predominantly attribute chronic low back pain to biomedical factors.Lebanese healthcare professionals need to improve communication with Lebanese patients regarding the nature of chronic low back pain, using clear communication to help dispel misconceptions and enhance rehabilitation outcomes.

BACKGROUND: Cancer-related pain is a global health-related problem associated with functional impairment, anxiety, depression, and reduced quality of life. The use of educational interventions for patients and their caregivers has been proposed as a promising tool for overcoming pain in cancer. The aim of this study was to summarize by means of a standardized methodological systematic revision the actual pain education intervention used in cancer patients and their caregivers and to analyze its effects on pain.
METHODS: A search was conducted through PubMed, Web of Science, Scopus and Cinhal from their inception to September 2022. Randomized controlled trials which included pain education interventions were identified. Two reviewers performed independent data extraction and methodologic quality assessments of these studies.
RESULTS: A total of seven studies was included in the study. The meta-analysis showed that pain education interventions have a significant effect on the worst pain; however, there was no effect on average pain.
CONCLUSIONS: Pain education interventions addressed to patients and their caregivers could have positive effects on cancer-related pain. It is recommended that a minimum of three sessions of about one hour\'s duration be held once a week. Further research needs to be carried out and analyzed on the effects over the long term. Pain education interventions show positive results in improving pain in cancer patients regardless of etiology or extent of the cancer. Studies with better methodological quality should be carried out to address specific components related to education interventions.

UNASSIGNED: Spinal cord injury (SCI) often leads to neuropathic pain that negatively affects quality of life. Several qualitative research studies in individuals with SCI who experience neuropathic pain indicate the lack of adequate information about pain. We previously developed an educational resource, the SeePain, based on scientific literature and a series of qualitative interviews of people with SCI, their significant others/family members, and SCI healthcare providers.
UNASSIGNED: However, to quantitatively evaluate the utility of this educational resource in a larger sample, we examined the agreement and usefulness ratings of statements regarding clarity/comprehensibility, content, and format of the SeePain, derived from the thematic analysis of our previous qualitative interviews. Participants completed a survey that provided a digital version of the SeePain and then rated their agreement/usefulness with the statements using numerical rating scales.
UNASSIGNED: There were overall high perceived agreement and usefulness ratings regarding the SeePain\'s clarity, content, and format. A factor analysis reduced the agreement and usefulness ratings into 4 components (content, clarity, format, and delivery medium). Group comparisons showed that individuals with higher education were more likely to endorse electronic and website formats, and the usefulness of a shorter version of the SeePain; females and younger individuals showed greater endorsement for clarity. Finally, higher pain intensity ratings were associated with greater agreement and usefulness of the content of the SeePain.
UNASSIGNED: Overall, these results support the utility of the SeePain as a source of information regarding pain that may facilitate communication about pain and its management following SCI.

Many physiotherapists do not feel adequately equipped to address psychosocial risk factors in people with complex pain states. Hence, a biopsychosocial blended intervention (Back2Action) was developed to assist physiotherapists to manage people with persistent spinal pain and coexisting psychosocial risk factors associated with the development or maintenance of persistent pain.
This study aimed to gain insight into the experiences of physiotherapists with this blended psychosocial intervention.
and methods: This was an interpretative qualitative study with a reflexive thematic analysis of semi-structured interviews with physiotherapists (N = 15) who delivered Back2Action. The interview started with the grand-tour question: \"What was your experience in using Back2Action?\" Physiotherapist were encouraged to provide examples, and follow-up questions were posed to ensure a deeper understanding could be reached.
Four themes were constructed: Physiotherapists became increasingly aware of (1) their own implicit expectations, biases and skills, and underlying treatment paradigms, and (2) the implicit expectations from their patients towards them. This led to (3) creating a deeper and stronger therapeutic alliance with the patient, but also (4) an understanding that implementation of a true biopsychosocial intervention - even if offered in a blended form - requires more practice, confidence and resources.
Back2Action is considered a valuable treatment to deliver a biopsychosocial intervention in primary care. Considering the high level of knowledge, skills and competency of the participating physiotherapists, the perceived barriers may be more difficult to overcome for more junior physiotherapists.

UNASSIGNED: Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice.
UNASSIGNED: Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital\'s Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education.
UNASSIGNED: Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities.
UNASSIGNED: Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families.

Review of a practical resource providing children with ongoing pain (and their parents) information of the neurobiology of pain. The book \'My Bodyguard Brain - How your brain uses pain to protect you\' explains why we feel pain. The brain makes pain when it notices any sort of danger. Pain is associated with acute injury but it can also be evoked by social interaction and unpleasant emotion that children don\'t know how to deal with. The text and drawings explain in a child-friendly way how your \'Bodyguard\' brain wants to look after you, and how it sometimes gets a bit \'too good\' at that job. It is a book I would recommend for teachers and clinicians dealing with children experiencing chronic pain. Ongoing pain in children is a huge problem in society. Paediatric pain should matter to everyone. It affects approximately one quarter to one third of all children and adolescents. Children with chronic pain have often cut back all their normal activities like school, sports, social life and sleep. Almost 60% of these children become adults experiencing pain and 50% of the children with pain has a parent suffering from chronic pain. Understanding what you feel will turn the oversensitive alarm down and is the first step to improve the lives of children and adolescents with pain.

BACKGROUND: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change.
OBJECTIVE: This study aims to assess the APM self-management program\'s feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management.
METHODS: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays.
RESULTS: Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview\'s first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change.
CONCLUSIONS: These findings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity.
BACKGROUND: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652.

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BACKGROUND: Chronic shoulder pain may cause significant functional disability and reduced psychosocial well-being. Detailed Case Description: In this case, we propose the use of pain neuroscience education and whole-body cryostimulation (WBC) to treat a 64-year-old woman with severe functional limitations and chronic right shoulder pain. The aim was to overcome kinesiophobia and improve her motor function, autonomy, and quality of life. Functional and clinical assessments were conducted at admission, discharge, and at a one-month follow-up via phone call. The patient\'s global health, shoulder function, and quality of life showed improvement during hospitalisation and were maintained after one month.
CONCLUSIONS: Pain education is crucial in managing chronic shoulder pain, especially in addressing kinesiophobia and promoting positive patient outcomes. In this context, WBC was used as a supplementary treatment to traditional pain relief and exercise tolerance therapies. This can help individuals to participate more actively in their rehabilitation process, ultimately promoting functional recovery and an improved quality of life.
CONCLUSIONS: The combination of cryostimulation, tailored physical exercises, pain education, manual therapy, and psychological support created a synergistic effect that addressed both the physical and psychological aspects of pain and kinesiophobia.