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Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.

ABSTRACT: BACKGROUND:Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments. OBJECTIVES:(1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not. METHOD:A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4-6?months, and after 1?year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not. RESULTS:Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial. CONCLUSION:Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise.

SUBMITTER: Karlsson L

PROVIDER: S-EPMC5028021 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.

Karlsson Linn L Gerdle Björn B Takala Esa-Pekka EP Andersson Gerhard G Larsson Britt B

SAGE open medicine 20160915

<h4>Background</h4>Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments.<h4>Objectives</h4>(1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who c ...[more]

PMID: 27688880

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Project description:BACKGROUND CONTEXT:Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments. PURPOSE:This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA. STUDY DESIGN/SETTING:Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed. PATIENT SAMPLE:A total of 241 older adults (?65 years) with chronic mechanical neck pain comprised the patient sample. OUTCOME MEASURES:The outcome measures were direct and indirect costs, neck pain, neck disability, SF-6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1-year time horizon. METHODS:This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308). A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectivenesswas a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates. RESULTS:Total costs for SMT+HEA were 5% lower than HEA (mean difference: -$111; 95% confidence interval [CI] -$1,354 to $899) and 47% lower than SRE+HEA (mean difference: -$1,932; 95% CI -$2,796 to -$1,097). SMT+HEA also resulted in a greater reduction of neck pain over the year relative to HEA (0.57; 95% CI 0.23 to 0.92) and SRE+HEA (0.41; 95% CI 0.05 to 0.76). Differences in disability and QALYs favored SMT+HEA. The probability that adding SMT to HEA is cost-effective at willingness to pay thresholds of $50,000 to $200,000 per QALY gained ranges from 0.75 to 0.81. If adopting a health-care perspective, costs for SMT+HEA were 66% higher than HEA (mean difference: $515; 95% CI $225 to $1,094), resulting in an ICER of $55,975 per QALY gained. CONCLUSION:On average, SMT+HEA resulted in better clinical outcomes and lower total societal costs relative to SRE+HEA and HEA alone, with a 0.75 to 0.81 probability of cost-effectiveness for willingness to pay thresholds of $50,000 to $200,000 per QALY.

Project description:BackgroundDifferent types of exercises can help manage chronic neck pain. Supervised exercise interventions are widely used, but these protocols require substantial resources. The aim of this trial, which focused on adherence, was to evaluate two home exercise interventions.MethodsThis parallel group randomized controlled trial included 57 women randomly allocated into two groups - a strength training group (STRENGTH, 34 subjects) and a stretching group (STRETCH, 23 subjects). The interventions focused on the neck and shoulder muscles and lasted for 12 months. The STRENGTH group performed weight training and ended each session with stretching exercises. These stretching exercises constituted the entirety of the STRETCH group's training session. Both groups were instructed to exercise three times per week. All the participants kept an exercise diary. In addition, all participants were offered support via phone and e-mail. The primary outcomes were pain intensity and function. The trial included a four- to six-month and a twelve-month follow-up. A completer in this study exercised at least 1,5 times per week during eight unbroken weeks. A responder in this study reported clinically significant improvements on pain and function. The statistical analyses used the Mann Whitney U-test, Wilcoxon signed-rank test, and X2 test.ResultsAt four- to six-months, the numbers of completers were 19 in the STRENGTH group and 17 in the STRETCH group. At twelve months, the corresponding numbers were 11 (STRENGTH) and 10 (STRETCH). At four- to six-months, the proportions of subjects reporting clinically important changes (STRENGTH and STRETCH) were for neck pain: 47% and 41%, shoulder pain: 47% and 47%, function: 37% and 29%. At twelve months, the corresponding numbers were for neck pain: 45% and 40%, shoulder pain: 55% and 50%, function: 55% and 20%.ConclusionsNo differences in the two primary outcomes between the two interventions were found, a finding that may be due to the insufficient statistical power of the study. Both interventions based on home exercises improved the two primary outcomes, but the adherences were relatively low. Future studies should investigate ways to improve adherence to home exercise treatments.Trial registrationClinicalTrials.gov Id: NCT01876680.

Project description:BACKGROUND:Physical inactivity and chronic pain are both major public health concerns worldwide. Although the health benefits of regular physical exercise are well-documented, few large epidemiological studies have investigated the association between specific domains of physical exercise and chronic pain in young adults. We sought to investigate the association between frequency, intensity and duration of physical exercise, and chronic pain. METHODS:Data stem from the SHoT2018-study, a national health survey for higher education in Norway, in which 36,625 fulltime students aged 18-35 years completed all relevant questionnaires. Chronic pain, defined according to the International Classification of Diseases 11th Revision (ICD-11), was assessed with a newly developed hierarchical digital instrument for reporting both distribution and characteristics of pain in predefined body regions. Physical exercise was assessed using three sets of questions, measuring the number of times exercising each week, and the average intensity and the number of hours each time. RESULTS:The majority (54%) of the students reported chronic pain in at least one location, and the prevalence was especially high among women. The overall pattern was an inverse dose-response association between exercise and chronic pain: the more frequent, harder or longer the physical exercise, the lower the risk of chronic pain. Similar findings were generally also observed for the number of pain locations: frequent exercise was associated with fewer pain locations. Adjusting for demographical, lifestyle factors and depression had little effect on the magnitude of the associations. CONCLUSION:Given the many health benefits of regular exercise, there is much to be gained in facilitating college and university students to be more physically active, ideally, thru a joint responsibility between political and educational institutions. Due to the cross-sectional nature of the study, one should be careful to draw a firm conclusion about the direction of causality.

Project description:BackgroundNeck pain is frequent among military helicopter pilots and crew-members, and pain may influence individual health and work performance. The aim of this study was to examine if an exercise intervention could reduce neck pain among helicopter pilots and crew-members.MethodsThirty-one pilots and thirty-eight crew-members were randomized to either an exercise-training-group (n = 35) or a reference-group (n = 34). The exercise-training-group received 20-weeks of specific neck/shoulder training. The reference-group received no training.Primary outcomeIntensity of neck pain previous 3-months (scale 0-10).Secondary outcomesadditional neck/shoulder pain intensity variables and pressure-pain-threshold in the trapezius muscle (TRA) and upper-neck-extensor muscles (UNE). Regular training adherence was defined as ≥1 training session a week. Statistical analyses performed were intention-to-treat and per-protocol. Students t-test was performed (p < 0.05).ResultsIntensity of neck pain previous 3-months at baseline was: 2.2 ± 1.8 and previous 7-days: 1.0 ± 1.5, and pressure-pain-threshold in TRA and UNE (right/left) was in kPa: 424 ± 187 / 434 ± 188 and 345 ± 157 / 371 ± 170 in the exercise-training-group, and 416 ± 177 / 405 ± 163 and 334 ± 147 / 335 ± 163 in the reference-group, with no differences between groups. Intention-to-treat-analysis revealed no significant between-group-differences in neck pain intensity and pressure-pain-threshold. Between-group-differences, including participants who trained regularly (n = 10) were also non-significant. Within-group-changes were significant among participants with regular training adherence in the exercise-training-group regarding intensity of neck pain previous 3-months (from 2.2 ± 0.6 to 1.3 ± 1.3, p = 0.019). Likewise, within the whole exercise-training-group, neck pain previous 7-days decreased (from 1.0 ± 1.4 to 0.6 ± 1.1, p = 0.024). Additional within-group-changes regarding pressure-pain-threshold in kPa were for the reference-group a reduction in TRA and UNE (right/left) to: 342 ± 143 / 332 ± 154 and 295 ± 116 / 292 ± 121 implying increased pain sensitivity, while for the exercise-training-group only a reduction in left TRA was seen: 311 ± 113.ConclusionsThe exercise intervention did not reduce neck pain among helicopter pilots and crew-members as no significant between-group-differences were found. However, some trends were demonstrated as some neck pain intensity and sensitivity improved more within the exercise-training-group but not within the reference-group. The lack of effect may be due to low adherence since only ~ 1/3 of subjects in the exercise-training-group engaged in regular training which may be due to the self-administration of the training.Trial registrationsEthical committee of Southern Denmark (S-20120121) 29 August, 2012. Clinical Trail Registration ( NCT01926262 ) 16 August, 2013.

Project description:Background:We investigated interactions between genetic and psychological factors in predicting shoulder impairment phenotypes. We hypothesized that pro-inflammatory genes would display stronger relationships compared with pain-related genes when combined with psychological factors for predicting phenotypic changes. Subjects and methods:Altogether, 190 participants completed a 5-day experimental protocol. An experimental shoulder injury model was used to induce physical impairment, and a priori selected genetic (pain-related, pro-inflammatory) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as predictors of interest. Impairment phenotypes were injury-induced deficits in range of motion (ROM) and strength. After controlling for age, sex, and race, genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each phenotype. Results:Strong statistical evidence was provided for interactions between: 1) IL-1? (rs1143634) and fear of pain for predicting loss of shoulder flexion and abduction, 2) IL-1? (rs1143634) and anxiety for predicting loss of flexion, and 3) IL-1? (rs1143634) and depressive symptoms for predicting loss of internal rotation. In addition, the interaction between OPRM1 (rs1799971) and fear of pain as well as COMT (rs4818) and pain catastrophizing provided strong statistical evidence for predicting strength loss. Conclusion:Pro-inflammatory gene variants contributed more to physical impairment with two single nucleotide polymorphisms (SNPs; IL-1? [rs1143634] and TNF/LTA [rs2229094]) interacting with psychological factors to predict six shoulder impairment phenotypes. In comparison, two pain-related gene SNPs (OPRM1 [rs1799971] and COMT [rs4818]) interacted with psychological factors to predict four shoulder impairment phenotypes (abduction: 5-day average loss; strength loss: 5-day average, peak, and relative loss).

Project description:BackgroundChronic neck pain is a leading cause of disability worldwide, affecting the lives of millions of people. Research investigating functional brain alterations in relation to somatosensory function is necessary to better understand mechanisms underlying pain development and maintenance in individuals with chronic neck pain, yet remains scarce. This case-control study aimed to examine resting-state functional connectivity alterations and associations with pain outcomes, self-reported central sensitization-related symptoms and quantitative sensory testing (QST) measures in patients with chronic non-traumatic (idiopathic/CINP) neck pain and chronic traumatic (whiplash associated/CWAD) neck pain compared to pain-free controls.MethodsResting-state functional magnetic resonance images were acquired in 107 female participants (38 CINP, 37 CWAD, 32 healthy controls). After data pre-processing, seed-to-seed analyses were conducted focusing on resting-state functional connectivity involving pre-defined regions of interest that have previously been observed to be structurally or functionally altered and/or associated with pain-related measures in this patient population.ResultsFindings demonstrate enhanced left amygdala functional coupling during rest with the left frontal operculum in women with CINP and CWAD compared to controls. This increased resting-state functional connectivity was associated with more self-reported symptoms related to central sensitization and decreased efficacy of conditioned pain modulation. Furthermore, enhanced connectivity between the left amygdala and left frontal orbital cortex, and between the left pallidum and the left frontal operculum was observed only in patients with CWAD compared to healthy controls. In patients, additional associations between local hyperalgesia and enhanced connectivity between the left superior parietal cortex and the left and right precentral gyrus were found.ConclusionsIn line with our hypotheses, patients with CWAD showed the most pronounced alterations in resting-state functional connectivity, encompassing subcortical limbic (amygdala) and basal ganglia (pallidum), and ventral frontal regions (frontal operculum, orbitofrontal cortex) when compared to CINP and controls. Findings are generally in line with the idea of a continuum, in absence of significant group differences across CINP and CWAD. Enhanced amygdala-frontal operculum functional connectivity was the most robust and only connectivity pair in the cluster that was associated with QST (i.e., dynamic QST; endogenous pain inhibition), and that was observed in both patient groups. In addition, independent of group differences, enhanced resting-state functional connectivity between superior parietal cortex (involved in attention) and primary motor cortex was associated with static QST (i.e., greater local hyperalgesia). Taken together, our findings show a key role for enhanced amygdala-ventral frontal circuitry in chronic neck pain, and its association with diminished endogenous pain inhibition further emphasizes the link between cognitive-affective and sensory modulations of pain in women with chronic non-traumatic and traumatic neck pain.

Dataset Information

Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.

Publications

Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.

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