Pain and Rehabilitation is a peer-reviewed, fully open access journal of the Physiotherapy Pain Association, a Professional Network of the Chartered Society of Physiotherapy.
Copyright © [Authors]. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Licence (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effectiveness of additional cognitive behavioural interventions on pain, catastrophising, kinesiophobia and anxiety in people with whiplash-associated disorders compared to physiotherapy alone: A systematic review
Background Among patients with whiplash-associated disorders (WAD), psychological distress can appear in forms of anxiety, depression or behavioural irregularities. Cognitive behavioural interventions (CBI) aim to influence such issues and thereby the pain experience. Objectives The purpose of this review is to synthesise the current state of evidence regarding the effectiveness of additional CBIs on pain, kinesiophobia, catastrophising and anxiety in people with WAD compared to physiotherapy alone. Data sources AMED, CINAHL, MEDLINE, PsycARTICLES, SPORTDiscus, PubMed and PEDro were searched from inception to 9 February 2019, complemented with a search update up to September 2021. Study selection Randomised controlled trials were included. Study appraisal and synthesis methods Quality appraisal and reporting incorporated the Cochrane Risk of Bias 2 tool and GRADE approach. Results Six studies were included. The evidence for all outcomes was uncertain. The findings as to whether CBIs in addition to physiotherapy are more effective in reducing pain intensity, kinesiophobia and anxiety than physiotherapy alone are conflicting. Regarding catastrophising, there are consistent findings that additional CBIs are not more effective. Limitations The review was not registered beforehand. Only one reviewer performed study selection, appraisal and data synthesis. Conclusion and implications of key findings Due to high risk of bias and very low methodological quality, the evidence is very uncertain about the effectiveness of additional CBIs. Their general addition to physiotherapy should be recommended cautiously.
Copyright (c) 2022 Stefanie Terhorst, Thomas Hering, Katja Ehrenbrusthoff (Author) https://creativecommons.org/licenses/by/4.0
Delivering NHS Community Pain Service Pain Management Programmes during Covid 19 via video conferencing: patient and clinician experiences and outcomes
Objective This article, with patient and clinician authorship, has two parts. Part one describes the development of a co-produced solution-focused (SF) virtual Pain Management Programme (vPMP) in an NHS community setting during year one of the Covid-19 pandemic, using live video conferencing. Part two reports on a service evaluation exploring vPMP outcomes in the context of service aims and objectives. Design 17 patients with a range of chronic pain conditions completed 9-week multidisciplinary vPMPs from July 2020 - January 2021. Quantitative and qualitative data were collected. Results Statistically and clinically significant improvements in pre-post pain self-efficacy, mental well-being, and function, and significant statistical improvement in hope were found (despite no significant changes in pain intensity or interference), broadly consistent with the service’s face-to-face (f2f) PMP outcomes and with other studies. An in-house tool “iGro” captured personalised change, with patients reporting an increased sense of their ‘best hopes’ becoming actualised post-PMP. Thematic analysis identified four main themes; ‘Emotional Well-Being’, ‘Pain Management Solutions’, ‘Changed Attitude’ and ‘vPMP Access’. High levels of attendance and engagement were observed. Conclusions The practice-based design necessitates caution be exercised with interpretation and generalisability. Nonetheless, preliminary outcomes provide tentative evidence that this SF vPMP was an effective, accessible and meaningful remote intervention.
Copyright (c) 2026 Rebecca Simm, Susan England, Faheema Patel (Author) https://creativecommons.org/licenses/by/4.0
Ten Footsteps 2021. An Online course to support self-management of pain
Objective To describe an online self-management course that was piloted as part of Footsteps 2021, an online festival provided on a voluntary basis by a team of health care professionals and experts by experience with the intention of supporting people to live well with pain. Design A feasibility study to assess who would engage with the course and potential areas of benefit. The Ten Footsteps Course mirrors a multidisciplinary pain management programme and was offered to anybody who identified that they would find it helpful to attend the sessions. Results A pre-course survey indicated that people who signed up were familiar with the idea of self-management and were largely in alignment with its ethos. Scores completed on a range of questionnaires were in alignment with those reported from formal pain management services. Thirty-two people completed the pre-course questionnaire. Only nine people completed a follow-up questionnaire at the end of the course. At the end of the course average reported levels of self-efficacy were higher and catastrophizing were lower compared to at the beginning while pain intensity and overall wellbeing did not differ at the two timepoints. Conclusions Pain self-management support co-produced and delivered in an open access format is of interest to people living with pain and some appear to benefit. There is a need to explore how this intervention can be made more accessible, including the use of different formats of delivery.
Copyright (c) 2022 Chris Penlington, Jenny Ashmore, Mark Agathangelou, Rosie Cruickshank, Frances Cole (Author) https://creativecommons.org/licenses/by/4.0
Charting medical students’ attitudes and beliefs towards people with chronic pain as they progress through their undergraduate programme: An observational study.
Background Healthcare professionals’ (HCPs’) attitudes towards pain influence their pain management. Attitudes about pain should be aligned with the evidence-base at the undergraduate stage of an HCP’s career but pain education at undergraduate level is often lacking, and negative attitudes can pervade HCP practice. Previous studies investigating change in pain attitudes in undergraduate HCPs are cross-sectional in nature and frequently report minimal change in pain attitudes. Objectives To investigate medical students’ attitudes and beliefs towards people with chronic pain over the course of their Scottish undergraduate programme. Design Five year observational study. Setting A Scottish university medical school. Participants Medical students were recruited in first year and followed up to their final year (year one n=205/244, year two n=190/245, year three n=132/279, year four n=110/262, year four n=159/260) for five years. Outcome Measure The Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS with scores ranging from 15-105) was completed annually. Results A two-way ANOVA found that attitudes and beliefs improved significantly (p<0.01) from first to final year (10.0 10.0). Medics showed a gradual reduction in scores (signifying improved attitudes) annually. Conclusions This is the first known published study to chart changes in the same cohort of medical students’ attitudes and beliefs towards people with chronic pain over time. Changes in attitudes improved steadily over the five year medical degree course. Future work should explore which aspects of degree courses, if any, impact upon attitudes and beliefs towards people with chronic pain so that courses can be enhanced accordingly.
Copyright (c) 2022 Jagjit Mankelow, Cormac G. Ryan, Hayley T Morris, Douglas Lauchlan, Christopher Seenan, Paul Taylor, Denis Martin (Author) https://creativecommons.org/licenses/by/4.0
Exploring the experiences of diagnosis and physiotherapy management in patients with hypermobility spectrum disorders and shoulder instability: a focus group report.
Objective To explore patients experiences of the diagnosis and management of hypermobility spectrum disorders (HSD)and shoulder instability. Design An exploratory qualitative design. A focus group was organised, transcribed, and analysed. The collected data was analysed using a thematic approach. Setting A single NHS Trust within the UK Participants Four people with HSD and shoulder instability Results All participants identified difficulties and delays in receiving a diagnosis for their HSD. They reported a lack of awareness amongst health care professionals, including physiotherapists. The participants described mixed experiences of physiotherapy treatment and alongside a perceived lack of awareness of HSD, they reported increased levels of anxiety prior to commencing treatment. Only one patient had received specialist shoulder physiotherapy for their shoulder instability resulting in a positive experience. Conclusions Physiotherapy is perceived by patients as an important component in the management of HSD and shoulder instability and should include appropriate exercise therapy and advice on joint management and on shoulder relocation. However, patients continue to report variable experiences of physiotherapy. Improving awareness and education amongst physiotherapists is essential for improving the experiences and long-term management of this patient group. Future work should explore what educational strategies would be optimal for health care professionals and which treatment strategies patients find the most beneficial.
Copyright (c) 2022 Melissa Johnson, Lucksy Kottam, Amar Rangan (Author) https://creativecommons.org/licenses/by/4.0
Painful diabetic neuropathy (PDN): an internet survey to the determine healthcare priorities of people with PDN.
Aims To determine the healthcare priorities of people with painful diabetic neuropathy (PDN) for managing the impacts of this condition. Methods An internet survey incorporating impacts of PDN developed from previous qualitative research, was distributed via diabetes support groups and on social media forum platforms. The survey asked respondents how frequently they experienced 58 impacts of PDN, how these impacts affected their quality of life, and the impacts they prioritised for better clinical management. Results The survey had 62 eligible and complete responses. The impacts with high frequency related to emotions, foot health and walking. The impacts with the greatest affect on quality of life related to psychological distress, social world, functional ability and sensory experiences. The impacts prioritised for better clinical management were: sleep, worry, functional ability and depression. Conclusions This study identified the top healthcare priorities of people with PDN, the topmost being help with sleep disturbance. There are existing evidence-based approaches, such as cognitive behavioural therapy for insomnia, which could help manage some of these priorities, but not all. These priorities could be used to develop a PDN-specific pain management programme.
Copyright (c) 2022 Dr Ben Davies, Prof Fiona Cramp, Jeremy Gauntlett-Gilbert, Prof Candida S Mccabe (Author) https://creativecommons.org/licenses/by/4.0
The digital interface is ready to see us all now….
Copyright (c) 2022 Mr Michael Mansfield , Prof Cormac Ryan (Author) https://creativecommons.org/licenses/by/4.0
Patients’ perceptions of a multidisciplinary pain management programme in relation to trauma-informed practice principles: a narrative-based qualitative service evaluation
Background: There is growing recognition of the importance of trauma-informed practice in pain care. However, the extent to which current delivery of a multidisciplinary pain management programme (PMP) based on acceptance and commitment therapy (ACT) aligns with principles of trauma-informed practice has not been evaluated. Therefore, the aims of this service evaluation were to gain an in-depth understanding of patients’ experiences of a routinely delivered ACT-based PMP in relation to principles of trauma-informed practice and use these findings to direct improvements for our service. Methods: This service evaluation used a qualitative methodology with individual patient interviews (n=10). All patients were completing an intensive ACT-based PMP in the service. Reflexive thematic analysis was combined with a narrative analysis approach to make sense of the data. Results: A superordinate theme was generated from the data, reflecting that trauma-informed practice is an evolving and continuous process over time. This superordinate theme was woven through the three other main themes: 1) Forming, expanding, and dissolving the “bubble”; 2) Balancing risks of distress with opportunities to engage, learn, and transform; and 3) Transformative self-narratives: hindrance to agency. Discussion: This service evaluation highlights areas of good practice with respect to trauma-informed principles within the delivery of a multidisciplinary PMP. The service evaluation findings have shaped further developments in training and clinical practice within our service. Ongoing reflexivity and meaningful engagement with diverse patient partners have been essential to continue to optimize the delivery of trauma-informed pain care.
Copyright (c) 2026 Clair Jacobs, Madeleine Anderson, Panayiota Chrysostomou, Kezia Kadri, Camille Leteurtre, Patrycja Jakubiec, Whitney Scott (Author) https://creativecommons.org/licenses/by/4.0
Delivery of the Comprehensive Multi-Disciplinary Combined Physical and Psychological Programme of the National Low Back and Radicular Pain Pathway in England and Wales: where do we stand?
Objectives This survey study aimed to map the current provision of the Comprehensive Multi-Disciplinary Combined Physical and Psychological Programme of the National Low Back and Radicular Pain Pathway in England and Wales. Design Online Survey. Setting England and Wales. Participants In total there were 66 respondents; 18 Trusts provided a full data set for their programmes - one delivered in Wales and 17 in England. Results All programmes met the core criteria for CPPP laid out in the Pathway but there was great variation in many key areas of content, outcome data collected, structure and delivery mode and staffing. Discussion The variation seen reflects a non-standard quality and nature of care across England and Wales. This likely reflects the absence of detail to inform NHS Commissioning in the corresponding NICE Guidelines, which in turn arises from the paucity of robust, pragmatic, evidence of efficacy and effectiveness of different models of CPPP. Conclusions Robust, pragmatic, evaluation of CPPP service provision is required to inform NHS Commissioning and bring best care to all. A standard ‘data dictionary’ of outcomes would facilitate cross-site comparison and enable ongoing monitoring of provision across sites.
Low Back Pain, Chronic Pain, Pain Management
Copyright (c) 2026 Alasdair MacSween, Ruth Newsome, Louise White, Alastair Dickson, James Greenwood, Diarmaid Ferguson, Rita Santos, Cormac Ryan, Denis Martin (Author) https://creativecommons.org/licenses/by/4.0
An ecosystem of living with severe, long-term pain – the role of (un)accepting systems: a qualitative study
Background: Coming to terms with chronic pain is a complex process. In earlier research, we found that accepting chronic pain is a fluid and continuous journey, experienced within socio-cultural-political worlds, which we conceptualised as an Ecosystem. These findings showed potentially unequal opportunities to experience a positive state of acceptance, with scope for improvements. We did not know how people living with chronic pain may relate to the findings. We therefore aimed to contextualise our (earlier) findings with people who live with chronic pain and experience marginalisation, and to generate ideas for improvement based on the concept of any individual journey with acceptance taking place within an ‘Ecosystem.’ Methods: We recruited through NHS contacts. We used focus groups and diaries to collect qualitative data, which we explored using thematic analysis. The research is exploratory in nature. Results: We recruited seven participants (two men, five women), all living with severe chronic pain and multiple long-term conditions. Most described difficulty making ends meet, none were in paid employment, nor had university degree level of formal education. We found three themes from the qualitative data analysis, two focused on structural, systemic features: ‘unaccepting, disconnected and dehumanising systems: treated like ‘tick boxes,’’ and ‘connected, understanding and accepting systems: towards inclusion.’ One theme showed the individual nature of experiences; ‘individual variations in the experiences and journey of coming to terms and living with chronic pain.’ Conclusions: Our findings show new insights into phenomena associated with coming to terms (and living) with chronic pain; including how state systems, structures and societal attitudes can influence experiences. Individuals with chronic pain may accept aspects of their painful condition, however, others around them, healthcare staff and institutional structures may not accept (or account for) the nature of chronic pain, leading to distress, stigmatisation, and feeling misunderstood. We demonstrate a focus on working with individuals with chronic pain, without socioeconomic privilege, to give insights into their lives and the impact of social context including political decisions – pain is unavoidably political for those at the sharp end of these experiences.
Copyright (c) 2026 Cassandra Macgregor, David N Blane, Sivaramkumar Shanmugam, Chris Seenan (Author) https://creativecommons.org/licenses/by/4.0
Explore pain perception and pain self-efficacy in acrobats in the context of holistic management: a scoping review.
Background: Within the acrobatic community, there is a strong belief that pain, defined as “an unpleasant sensory and emotional experience associated with; or resembling that associated with actual or potential tissue damage”, is normal when training and performing. Acrobats are subject to extraordinary physical and psychological demands, sometimes leading to pain and injury, which has an impact on their performance and well-being. Objective: This research aimed to explore the physical and psychological factors that influence pain perception and pain self-efficacy and identify best practices which will inform pain management in acrobats. This research will be useful to summarise the existing literature evidence in this area which could inform future research projects around holistic pain management. Design: A literature search of ProQuest and Web of Science databases was undertaken for the period between 2012 to 2023, using the search terms “pain”, “pain perception” and “self-efficacy” in those who practised the following acrobatic disciplines: circus performers, gymnasts, and cheerleaders. Results: 28 studies were identified to form the key findings of this review. This research found that pain in acrobats could be identified as either injury-related or performance-related. Risk factors for pain included internal, external, and psychological factors. Some acrobats believe in “no pain, no gain,” which implies a high self-efficacy, that is the ability to continue training despite the pain. The findings suggest that a holistic pain management approach, involving multiple stakeholders, may incorporate the following components: 1) maintaining a healthy physical condition, 2) reviewing training load, 3) managing stress, 4) differentiating pain, and 5) sharing available resources. A positive relationship with coaches and teachers is key in the early identification and treatment of pain. Conclusion: In conclusion, this scoping review offered insight into pain behaviours and explored best practices around holistic pain management in acrobats. To manage pain, it is recommended to address the following: general health, training loads, stress, pain self-identification and signpost to resources. These strategies could help reduce pain incidents and promote career longevity.
Copyright (c) 2025 Bethany Shum, Isabel Artigues (Author) https://creativecommons.org/licenses/by/4.0
Presentations of Functional Neurological Symptoms following orthopaedic surgery: a retrospective case series
Abstract Background: This case series aimed to describe the characteristics and symptomatic profile of patients presenting with symptoms of Functional Neurological Disorder (FND) following orthopaedic surgery and explore their impact on clinical services. Methods: This retrospective case series evaluated data from hospital clinical records of adult inpatients who presented with FND symptoms following orthopaedic surgery. Data were analysed narratively and using descriptive statistics. Results: Five patients were included; four were female with an age range of 41 to 57 years. All five had a history of chronic pain and deteriorating mobility and three had a mental health disorder. Four patients had undergone spinal surgery and four exhibited functional motor symptoms. Length of admission ranged from 14 to 171 days and only two patients received a formal diagnosis during their inpatient stay. No local FND-specific services were available to any patients on discharge. Conclusions: All patients with suspected FND symptoms had extended lengths of admission, which may arise from absent pre-established management pathways. Potential barriers to diagnosis may include complex clinical presentations, lack of established diagnostic pathways and a limited awareness of FND. Future research is warranted to standardise screening and management pathways within the acute orthopaedic setting.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
Persistent Pain and Elective Orthopaedic Surgery: A Research and Rehabilitation Agenda for the NHS 10-Year Health Plan
Are the goals of the virtual exercise classes for musculoskeletal (MSK) conditions being met? A service evaluation
Background: The COVID-19 pandemic prompted a shift to virtual physiotherapy services in the UK, aiming for cost-effective and safe rehabilitation. This evaluation focused on the efficiency of virtual classes for managing non-urgent lower limb conditions amidst the gradual return of face-to-face (F2F) classes. As pandemic guidelines evolved, F2F exercise classes were re-integrated along with virtual exercise classes. At this time, virtual classes were thought to be essential to maintain patient treatment, but the service has not been evaluated concerning efficiency and (potential barriers affecting) patient uptake, also in light of the diverse community St. Mary’s Hospital - Imperial College serves. Methods: Forty-nine patient records were reviewed, assessing attendance, discharge rates, and outcomes. Virtual classes demonstrated good patient adherence (77%) and facilitated patient discharge (61%), reducing clinician time. However, missing data limited the assessment's comprehensiveness, notably regarding safety, barriers affecting class uptake, adverse events, and primary outcome measures like the Musculoskeletal Health Questionnaire (MSK-HQ; 98% missing). Results: The findings support the efficacy of virtual classes but highlight the need for more rigorous data collection and documentation standards to ensure a comprehensive evaluation. Key recommendations include improving clinician documentation, tracking patient-specific benefits, and conducting audits for clinical oversight. These actions are crucial for maintaining physiotherapy standards and enhancing the effectiveness of virtual exercise classes. Conclusion: Virtual classes demonstrate potential for managing lower limb conditions, showing good adherence and facilitating patient discharge. However, missing data underscores the importance of robust data collection and documentation. Future evaluations should focus on improving documentation standards and conducting audits for clinical oversight, essential for maintaining physiotherapy standards and optimising virtual exercise class outcomes.
Implementing a Psychology and Physiotherapy Pain Management Back programme within a Spinal Surgical Service: A Service Improvement Project.
Background: The backpack programme is a psychology and physiotherapy pain management programme aimed at reducing psychosocial risk factors associated with back pain. Psychosocial risk factors have been shown to negatively influence pain experience, thus impacting on function and disability. Evidence has shown that targeting modifiable risk factors through early identification can improve outcomes. Providing pain management interventions within the spinal surgical service may support people in the long-term management of their condition. Aim: To assess the feasibility and the acceptability of the backpack pain management programme in the spinal surgical service to inform service provision. Method: Feasibility was assessed through recruitment rate and retention as well as patient reported outcome measures pre- and post-group. Acceptability was assessed by patient experience questionnaires post-programme and thematic content analysis of qualitative audio interviews. Setting: The intervention took place in a pain management department at North Bristol NHS Trust. Results: The recruitment rate was initially slower than anticipated. 14 patients were referred by spinal consultants over a 5-month period and of those assessed, 11 were invited to the programme. Feasibility showed recruitment issues and dropouts at the start of the intervention. However, retention for group starters was good and outcome measures reflected improvements in function, confidence and quality of life. Emergent themes were understanding the condition, facilitating peer support and self-empowerment. For those completing the course, high acceptability and patient satisfaction was shown. Conclusion: The delivery of this intervention is feasible and acceptable for the attendees in this project, although dropout rates and recruitment issues need to be addressed in future service provision. Screening patients for psychosocial risk factors on initial consultation within spinal surgical services may allow stratification for the level of care provided. This would enable those who would benefit from a pain management approach to have support earlier in the pathway, thus impacting on longer term outcomes and improving quality care for patients.
Copyright (c) 2025 Melanie Berry, Oliver Muckleston (Author) https://creativecommons.org/licenses/by/4.0
Exploring the impact of metaphors and pain neuroscience education on adults with chronic musculoskeletal pain.
Background: Chronic musculoskeletal pain (CMP) is a significant global health concern. Metaphors are frequently used by people with CMP and form an integral component of pain neuroscience education (PNE). While numerous studies have explored metaphors, PNE and chronic pain, research specifically focusing on CMP remains limited. Objectives: This study aimed to (1) identify the use and impact of metaphors in individuals with CMP, (2) critically evaluate the literature on the effectiveness of PNE in this population, and (3) explore how PNE influences individuals with CMP. Data Sources: Nine online databases including Google Scholar, EMBASE, CINAHL, and ScienceDirect were searched from inception to 31 May 2022. Additionally, reference lists were manually searched for relevant studies. Study Selection: Included studies comprised of randomised controlled trials (RCTs), systematic reviews, and qualitative research. Study Appraisal and Synthesis: The selected studies were critically appraised using CASP checklists. Results: A total of 24 studies were analysed, consisting of six systematic reviews, 11 RCTs, and seven qualitative studies. Metaphors were found to facilitate the expression and narration of pain experiences amongst individuals with CMP. The effectiveness of PNE varied depending on participants' specific conditions. Strong evidence supported PNE’s ability to reduce pain, disability, catastrophising, and kinesiophobia in individuals with chronic low back pain (CLBP). However, the evidence for its effectiveness in non-spinal pain conditions was limited and inconclusive. Reconceptualisation of pain was identified as a critical process for PNE to be effective. Conclusions: PNE should be considered an essential intervention in the management of CLBP. Further RCTs are warranted to evaluate PNE’s efficacy in non-spinal CMP conditions and to determine its optimal delivery format.
Reimagining Pain Care: An invitation to rethink pain management
Changing Times in Pain, Science, and Practice
The fields of healthcare, science, and publishing are undergoing seismic changes, and with them come opportunities to address longstanding inequalities. Pain care, a field that intersects deeply with social determinants of health, is uniquely positioned to lead this charge. At Pain and Rehabilitation, we are committed to confronting health inequalities and embedding principles of equality, diversity, and inclusion (EDI) in all aspects of our work. This editorial reflects on the challenges and opportunities posed by these “changing times” and explores the role of artificial intelligence (AI), the journal’s new aims and scope, and the transition to a more accessible publishing platform in advancing this agenda.
Copyright (c) 2025 Chris Seenan (Author) https://creativecommons.org/licenses/by/4.0
A new pain post-doc’s review of EFIC 2022
Copyright (c) 2023 https://creativecommons.org/licenses/by/4.0
OldPain2Go® a novel intervention for people with chronic low back pain: a Feasibility study
Objectives: This feasibility study aimed to inform the development of a protocol for a single-blind randomised controlled trial (RCT) investigating the efficacy of OldPain2Go® for the treatment of chronic low back pain (CLBP). Design: Single arm feasibility study. Setting: One private physiotherapy practice. Participants: Twenty two individuals with CLBP were recruited and 15 completed the study providing full data sets (11 female, 4 male, mean age 49.3, range 18-71 years). Intervention OldPain2Go®, a novel talking therapy for pain. Participants received up to two individual treatment sessions with one therapist. Main Outcome Measures: Pain (0-10 pain Numerical Rating Scale) and function (Roland Morris Disability Questionnaire, 0-24, higher score indicates poorer levels of function), measured before and after all sessions and at 3-week follow-up. Results: The study recruited to target, only one participant withdrew from the study (unrelated to the study) and there were no adverse events/reactions attributed to the intervention. Of 15 participants, five received one treatment session and 10 received two sessions. Improvements in pain and function were seen in all those who completed the study with average improvements above the pre-set minimal clinically important change. Conclusions: Important methodological information was obtained, which will inform a future large-scale RCT of this intervention. As this was a feasibility study no claims about efficacy can be made. Future research to investigate the efficacy of this intervention is warranted. Trial registration: ClinicalTrials.gov Identifier: NCT03804567
Copyright (c) 2023 Alasdair MacSween, Drew Coverdale, Kate Swainston, Cormac Ryan, Denis Martin (Author) https://creativecommons.org/licenses/by/4.0
Virtual reality for pain related health literacy in people with persistent pain: protocol for a scoping review.
Background: Patient education remains a key element in the provision of healthcare for people with chronic or persistent pain and is used to help patients develop health-related skills leading to the improvement of health. When a patient understands the education they receive, they manage their health better. Patients with low health literacy find the management of long-term conditions more difficult therefore the requirement for better health literacy in patients with persistent pain is warranted. Virtual Reality may act as an effective tool for the development of patient education and health literacy and has been shown to be more effective than other methods of delivery, such as text reading. Objectives: To present a protocol for a scoping review which aims to establish and present a comprehensive overview of existing research on the use of virtual reality as a tool to promote pain related health literacy in patients with persistent pain. Data sources: We will conduct a systematic search of several electronic databases from inception to the present within CINAHL, PubMed, Embase, PsychInfo. Study selection or eligibility criteria: Studies which use virtual reality to provide education to patients who report persistent pain will be included. Study appraisal and synthesis methods: Data will be extracted and mapped against the Health Literacy Pathway Model to identify characteristics of health literacy within educational interventions. This will then be presented alongside descriptive statistics and narrative thematic analysis to illustrate patterns, similarities, gaps and opportunities associated with the research topic
A case report of Patient and Public Involvement and Engagement activities to explore the potential of zines as an arts-based tool to target the stigma of pain.
There is increasing evidence that stigma negatively affects the health and quality of life of people living with persistent pain. While there is a need to tackle stigma, the few studies investigating potential interventions to date have focused on individual-level interventions. However, self-stigma is experienced alongside external stigma that manifests in both private and public spheres, including interactions with healthcare providers and policies that affect the lives of people with pain. This case reports explored the potential to use zines, an art-based medium rooted in social justice activism, as an anti-stigma tool, in the context of persistent pain. This paper describes the collaborative Patient and Public Involvement and Engagement (PPIE) process to (1) develop and deliver zine-making workshops and (2) shape future research to understand zines as a potential tool to target pain-related stigma across the multilevel health ecosystem. Collaboration with patient advisors highlighted the need for inclusivity to be at the centre of zine workshops. Then considering potential for future research, people living with pain themselves and general practitioners were identified as priority groups to evaluate the impact of zines on pain-related stigma. This case report documents and shares learning about how PPIE can provide essential insights into developing and evaluating an inclusive intervention with potential to target stigma for people with pain.
patient and public involvement and engagement
Development of a Referral Tool for a Musculoskeletal Pain Management Service: A Service Improvement Project
Objectives: To develop an evidence-based patient referral guidance tool for clinicians referring to a complex pain management service. Design: In this service development project, a three-phase, pragmatic qualitative approach was used: 1) a systematic scoping search of the literature was undertaken; 2) a focus group was completed with staff in a complex pain management service and a draft referral tool constructed informed by the focus groups and scoping review; 3) a round of expert feedback on the draft tool was obtained via email and used to refine the final tool. Setting: The project took place in a complex pain management service in the North East of England. Participants: Staff members from a complex pain management service and experts in the field of pain management were contacted to provide their input into this project. Results: Phase One found that an aggregation of the following should prompt a referral to a specialist pain service: moderate-severe psychological distress; a diagnosis of fibromyalgia, chronic widespread pain, or complex regional pain syndrome; and that the individual has trialled a period of standard care before referral. Phase Two highlighted the difficulty in defining and identifying psychological distress and the absence of a universally accepted screening tool. Phase three provided feedback broadly supportive of the themes within the referral tool and clarified aspects of language and semantics. Conclusions: This project succeeded in achieving its primary aim. The resultant tool suggests key referral criteria for a complex pain service. Future work should evaluate this new referral tool's impact on the performance of the complex pain service it was designed for and associated patient outcomes. Future work should also explore the generalisability of these findings to other pain services with a view to enhancing referral systems for pain services nationwide.
Work is therapy, not a goal in itself, for people with chronic pain.
Pain has long been seen as an obstacle for work and many people living with chronic pain feel stigmatised in the workplace (e.g., feeling that their pain is experienced as an excuse not to work or as a sign of weakness)3. Although musculoskeletal pain is the leading cause of sick leave in Europe with estimated costs of up-to 2% of the GDP4, putting people with pain on sick leave is against general recommendations6,11. In this commentary, we will introduce the work-as-therapy concept as a plausible rehabilitation method and explain how it can benefit patients and their employers.
Pain education: The importance of being humorous.
After 10 years as (Co-) Editor-in-Chief of Pain and Rehabilitation, the time has come for me to step aside. It has been a great privilege to continue the journal started by the Great Louis Gifford and his equally wonderful wife Philippa. It has been a joy to work with an enthusiastic and hardworking editorial team and I would like to thank them for all their support over the years.