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Scientific Advances in the Non-Pharmacological Management of Chronic Pain

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 21840

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Special Issue Editor

Dr. Juan V. Luciano

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Guest Editor

1. Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 St. Boi de Llobregat, Spain
2. Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
Interests: effectiveness; cost-effectiveness; cost utility; randomized controlled trials; psychological treatment; biopsychosocial approach; psychometrics; patient-reported outcome measures
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic pain has a high prevalence in the general population worldwide. It is associated with severe functional impairment, poor quality of life, and elevated health care and societal costs. Chronic pain represents a great challenge for health professionals due to the lack of treatment options with high effect sizes. To date, the effectiveness of pharmacological interventions has been generally limited, and more ubiquitous effects have been found for non-pharmacological treatments such as aerobic exercise, pain neuroscience education, or some forms of cognitive behavioural therapy. For this Special Issue, cutting-edge research on the following topics is welcome. First, we need theory-driven therapies. It is crucial to show the effectiveness and cost-effectiveness of non-pharmacological therapies based on explicit theoretical models that guide the choice of therapeutic ingredients, treatment doses, timing, and the selection of empirically validated measures. Second, for comparability purposes, studies adopting the Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations will be strongly appreciated. Finally, there is a striking lack of studies including physiological variables as process or outcome variables in randomised trials of non-pharmacological treatments. The study of the neurobiological underpinnings of non-pharmacological treatments for pain is still in its infancy, so further research on this issue seems warranted.

Dr. Juan V. Luciano
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

effectiveness
cost effectiveness
cost utility
non-pharmacological treatment
biopsychosocial approach
IMMPACT
biomarkers
chronic pain

Published Papers (4 papers)

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Research

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11 pages, 774 KiB

Open AccessArticle

Psychological Therapy in Chronic Pain: Differential Efficacy between Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy

by Estela María Pardos-Gascón, Lucas Narambuena, César Leal-Costa, Antonio Jesús Ramos-Morcillo, María Ruzafa-Martínez and Carlos J. van-der Hofstadt Román

J. Clin. Med. 2021, 10(16), 3544; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163544 - 12 Aug 2021

Cited by 3 | Viewed by 2777

Abstract

The objective of this study is to evaluate the differential efficacy between Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT). A quasi-experimental design of repeated measures before and after the test (n = 57) was used with a non-equivalent control group from a previous cohort treated with CBT (n = 105). The t-test revealed significant differences in subjective quality of life for the MBCT group, and in quantity, optimum, and adequate sleep for the CBT group. The pre–post effect size comparison mostly showed slightly larger effect sizes in the MBCT group. CBT and MBCT had comparable efficacies, although a slight trend towards larger effect sizes in MBCT was found. Likewise, CBT seemed to improve sleep-related variables, while MBCT was associated with improvements in pain and quality of life. Full article

(This article belongs to the Special Issue Scientific Advances in the Non-Pharmacological Management of Chronic Pain)

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24 pages, 1424 KiB

Open AccessArticle

Effectiveness of a Multicomponent Treatment for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): A Pragmatic Randomized Controlled Trial

by Mayte Serrat, Míriam Almirall, Marta Musté, Juan P. Sanabria-Mazo, Albert Feliu-Soler, Jorge L. Méndez-Ulrich, Juan V. Luciano and Antoni Sanz

J. Clin. Med. 2020, 9(10), 3348; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103348 - 18 Oct 2020

Cited by 47 | Viewed by 8542

Abstract

A recent study (FIBROWALK) has supported the effectiveness of a multicomponent treatment based on pain neuroscience education (PNE), exercise therapy (TE), cognitive behavioral therapy (CBT), and mindfulness in patients with fibromyalgia. The aim of the present RCT was: (a) to analyze the effectiveness of a 12-week multicomponent treatment (nature activity therapy for fibromyalgia, NAT-FM) based on the same therapeutic components described above plus nature exposure to maximize improvements in functional impairment (primary outcome), as well as pain, fatigue, anxiety-depression, physical functioning, positive and negative affect, self-esteem, and perceived stress (secondary outcomes), and kinesiophobia, pain catastrophizing thoughts, personal perceived competence, and cognitive emotion regulation (process variables) compared with treatment as usual (TAU); (b) to preliminarily assess the effects of the nature-based activities included (yoga, Nordic walking, nature photography, and Shinrin Yoku); and (c) to examine whether the positive effects of TAU + NAT-FM on primary and secondary outcomes at post-treatment were mediated through baseline to six-week changes in process variables. A total of 169 FM patients were randomized into two study arms: TAU + NAT-FM vs. TAU alone. Data were collected at baseline, at six-week of treatment, at post-treatment, and throughout treatment by ecological momentary assessment (EMA). Using an intention to treat (ITT) approach, linear mixed-effects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more effective than TAU at posttreatment for the primary and secondary outcomes evaluated, as well as for the process variables. Moderate-to-large effect sizes were achieved at six-weeks for functional impairment, anxiety, kinesiophobia, perceived competence, and positive reappraisal. The number needed to treat (NNT) was 3 (95%CI = 1.6–3.2). The nature activities yielded an improvement in affective valence, arousal, dominance, fatigue, pain, stress, and self-efficacy. Kinesiophobia and perceived competence were the mediators that could explain a significant part of the improvements obtained with TAU + NAT-FM treatment. TAU + NAT-FM is an effective co-adjuvant multicomponent treatment for improving FM-related symptoms. Full article

(This article belongs to the Special Issue Scientific Advances in the Non-Pharmacological Management of Chronic Pain)

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16 pages, 809 KiB

Open AccessArticle

The Role of Positive Psychological Factors in the Association between Pain Intensity and Pain Interference in Individuals with Chronic Musculoskeletal Pain: A Cross-Sectional Study

by Javier Martinez-Calderon, Mar Flores-Cortes, Susana Clavero-Cano, Jose Miguel Morales-Asencio, Mark P. Jensen, Antonio Rondon-Ramos, Juan Luis Diaz-Cerrillo, Gina Rocío Ariza-Hurtado and Alejandro Luque-Suarez

J. Clin. Med. 2020, 9(10), 3252; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103252 - 12 Oct 2020

Cited by 8 | Viewed by 2977

Abstract

This study aimed to test the cross-sectional mediating and moderating role that positive psychological factors play in the association between pain intensity and pain interference in individuals with chronic musculoskeletal pain. A descriptive cross-sectional study using mediation analyses was conducted, including 186 individuals with chronic musculoskeletal pain. We conducted cross-sectional mediation and moderation analyses to determine whether the positive psychological factors mediated or moderated the association between pain intensity and pain interference. Pain acceptance, pain self-efficacy, and optimism were all significantly and weakly related to pain interference when controlling for pain intensity. Pain self-efficacy and pain acceptance partially mediated the association between pain intensity and pain interference. On the other hand, the multiple mediation model did not show significant effects. The three positive psychological factors were not found to significantly moderate the association between pain intensity and pain interference. The findings suggest that in chronic musculoskeletal pain patients, the treatments may focus on [i] what they are capable of doing to manage the pain (i.e., pain self-efficacy) and [ii] being better able to accept the pain as pain waxes and wanes might be also particularly helpful. However, these results must be tested in longitudinal studies before drawing any causal conclusion. Full article

(This article belongs to the Special Issue Scientific Advances in the Non-Pharmacological Management of Chronic Pain)

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Other

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16 pages, 652 KiB

Open AccessBrief Report

Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomized Controlled Trial

by Juan P. Sanabria-Mazo, Jesus Montero-Marin, Albert Feliu-Soler, Virginia Gasión, Mayte Navarro-Gil, Héctor Morillo-Sarto, Ariadna Colomer-Carbonell, Xavier Borràs, Mattie Tops, Juan V. Luciano and Javier García-Campayo

J. Clin. Med. 2020, 9(10), 3246; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103246 - 11 Oct 2020

Cited by 14 | Viewed by 6985

Abstract

The lack of highly effective treatments for fibromyalgia (FM) represents a great challenge for public health. The objective of this parallel, pilot randomized controlled trial (RCT) was two-fold: (1) to analyze the clinical effects of mindfulness plus amygdala and insula retraining (MAIR) compared to a structurally equivalent active control group of relaxation therapy (RT) in the treatment of FM; and (2) to evaluate its impact on immune-inflammatory markers and brain-derived neurotrophic factor (BDNF) in serum. A total of 41 FM patients were randomized into two study arms: MAIR (intervention group) and RT (active control group), both as add-ons of treatment as usual. MAIR demonstrated significantly greater reductions in functional impairment, anxiety, and depression, as well as higher improvements in mindfulness, and self-compassion at post-treatment and follow-up, with moderate to large effect sizes. Significant decreases in pain catastrophizing and psychological inflexibility and improvements in clinical severity and health-related quality of life were found at follow-up, but not at post-treatment, showing large effect sizes. The number needed to treat was three based on the criteria of ≥50% Fibromyalgia Impact Questionnaire (FIQ) reduction post-treatment. Compared to RT, the MAIR showed significant decreases in BDNF. No effect of MAIR was observed in immune-inflammatory biomarkers (i.e., TNF-α, IL-6, IL-10, and hs-CRP). In conclusion, these results suggest that MAIR, as an adjuvant of treatment-as-usual (TAU), appears to be effective for the management of FM symptoms and for reducing BDNF levels in serum. Full article

(This article belongs to the Special Issue Scientific Advances in the Non-Pharmacological Management of Chronic Pain)

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