Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Case-Cohort Study

O’Sullivan, Kieran; Dankaerts, Wim; O’Sullivan, Leonard; O’Sullivan, Peter

doi:10.2522/ptj.20140406

Cited by 92 publications

(91 citation statements)

References 63 publications

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“…The same information regarding psychosocial risk factors and pain mechanisms can be used to guide the treatment plan. For example, central sensitization has been proposed as a key factor in determining if a patient needs TNE (Louw, 2014;Louw, Puentedura, and Mintken, 2012;Moseley, 2007), and has high psychosocial risk factors (O'Sullivan, Dankaerts, O'Sullivan, and O'Sullivan, 2015;Zimney, Louw, and Puentedura, 2014). This understanding of the importance of psychosocial factors and pain mechanisms should guide PTs to "go beyond" typical interview questions.…”

Section: Assessing Painmentioning

confidence: 98%

Listening is therapy: Patient interviewing from a pain science perspective

Diener

Kargela

Louw

2016

Physiotherapy Theory and Practice

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The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain mechanism assessment.

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Section: Assessing Painmentioning

confidence: 98%

Listening is therapy: Patient interviewing from a pain science perspective

Diener

Kargela

Louw

2016

Physiotherapy Theory and Practice

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“…Interventions that focus on utilizing self-efficacy theory (13) may aid in reducing perceptions of pain or help in the relief of pain. Cognitive-behavioral interventions can help to develop self-efficacy using activities such as coping skills and self-management training with rehearsal and practice in the individual's daily environment (30)(31)(32). Successful experiences in pain control can produce the greatest changes in self-efficacy beliefs (14).…”

Section: Discussionmentioning

confidence: 99%

The role of mental health and self-efficacy in the pain experience of patients with amyotrophic lateral sclerosis

Stephens

Lehman

Raheja

et al. 2016

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

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Complex interactions between pain, depression, and anxiety impact quality of life in patients with ALS. Psychological approaches to pain control may be useful. This study explored the role of self-efficacy in mitigating pain. Individuals registered with the Agency for Toxic Substances and Disease Registry National ALS Registry and who experienced pain were invited to participate in an online survey. Subjects completed the Brief Pain Inventory-Short Form, Hospital Anxiety and Depression Scale, and Chronic Pain Self-Efficacy Scale. Correlations between variables were determined. Multiple linear regression models assessed relationships between depression, anxiety and self-efficacy predictions, and pain severity, interference, and relief. Results recorded that there were 197 participants (58% males, mean age 59 AE 10 years). Cases or borderline cases of depression or anxiety were common. Mean levels of pain were moderate. Higher pain self-efficacy scores predicted lower pain severity, lower pain interference, and higher pain relief with treatment. As depression scores increased, pain interference with daily life was higher. In conclusion, anxiety and depression are common in patients with ALS and pain. Self-efficacy appears to mitigate pain. A multifactorial approach to pain management should be considered in these patients, addressing mental health and self-efficacy to augment pharmacologic pain treatments.

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“…There is, however, a fundamental part to PNE that is often missed: "de-education" prior to "re-education" (O'Sullivan, Dankaerts, O'Sullivan, and O'Sullivan, 2015). PNE involves a paradigm shift, contrasting very prevalent biomedical models focusing on anatomy, biomechanics, and pathoanatomy (Moseley, 2007a;Nijs et al, 2012).…”

Section: Therapeutic Neuroscience Educationmentioning

confidence: 97%

The clinical application of teaching people about pain

Louw

Zimney

O'Hotto

et al. 2016

Physiotherapy Theory and Practice

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Teaching people about the neurobiology and neurophysiology of their pain experience has a therapeutic effect and has been referred to as pain neuroscience education (PNE). Various high-quality randomized controlled trials and systematic reviews have shown increasing efficacy of PNE decreasing pain, disability, pain catastrophization, movement restrictions, and healthcare utilization. Research studies, however, by virtue of their design, are very controlled environments and, therefore, in contrast to the ever-increasing evidence for PNE, little is known about the clinical application of this emerging therapy. In contrast, case studies, case series, and expert opinion and perspectives by authorities in the world of pain science provide clinicians with a glimpse into potential "real" clinical application of PNE in the face of the ever-increasing chronic pain epidemic. By taking the material from the randomized controlled trials, systematic reviews, case series, case studies, and expert opinion, this article aims to provide a proposed layout of the clinical application of PNE. The article systematically discusses key elements of PNE including examination, educational content, and delivery methods, merging of PNE with movement, goal setting, and progression. This perspectives article concludes with a call for research into the clinical application of PNE.

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Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Case-Cohort Study

Abstract: These promising results suggest that cognitive functional therapy should be compared with other conservative interventions for the management of disabling NSCLBP in secondary care settings in large randomized clinical trials.

Cited by 92 publications

References 63 publications

Listening is therapy: Patient interviewing from a pain science perspective

Listening is therapy: Patient interviewing from a pain science perspective

The role of mental health and self-efficacy in the pain experience of patients with amyotrophic lateral sclerosis

The clinical application of teaching people about pain

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