The purpose of this prospective case series was to observe and describe changes in patients with chronic cervico-craniofacial pain of muscular origin treated with multimodal physiotherapy based on a biobehavioral approach. Nine patients diagnosed with chronic myofascial temporomandibular disorder and neck pain were treated with 6 sessions over the course of 2 weeks including: (1) orthopedic manual physiotherapy (joint mobilizations, neurodynamic mobilization, and dynamic soft tissue mobilizations); (2) therapeutic exercises (motor control and muscular endurance exercises); and (3) patient education. The outcome measures of craniofacial (CF-PDI) and neck disability (NDI), kinesiophobia (TSK-11) and catastrophizing (PCS), and range of cervical and mandibular motion (ROM) and posture were collected at baseline, and at 2 and 14 weeks post-baseline. Compared to baseline, statistically significant (p < 0.01) and clinically meaningful improvements that surpassed the minimal detectable change were observed at 14 weeks in CF-PDI (mean change, 8.11 points; 95% confidence interval (CI): 2.55 to 13.69; d = 1.38), in NDI (mean change, 5 cm; 95% CI: 1.74-8.25; d = 0.98), and in the TSK-11 (mean change, 6.55 cm; 95% CI: 2.79-10.32; d = 1.44). Clinically meaningful improvements in self-reported disability, psychological factors, ROM, and craniocervical posture were observed following a multimodal physiotherapy treatment based on a biobehavioral approach.
Background The main objective of this study was to assess pain memory as well as long‐term episodic memory, both in patients with chronic pain (CP) and in asymptomatic participants (AP). Methods A prospective cohort study design was used. Sixty‐eight participants were divided into two groups: CP (n = 34) and AP (n = 34). The protocol consisted of taking eight tests, four painful provocation tests and four distracting tests, and completing a memory test on the order of the tests at the end of the experiment and at 1‐month post‐experiment. Results Patients with CP showed acceptable concordance in the classification, in ascending order from lower to higher pain perception, both post‐experiment and 1‐month post‐experiment (κ = 0.41–0.60, p < .001). No differences were found regarding recall of the order of the tests, but differences were found in painful tests isolated only post‐experiment in the CP group with a moderate effect size (p < .05, d = 0.77). Conclusions Patients with CP had a more reliable memory than AP in relation to the memory of the pain caused experimentally until at least 1 month after the experiment. Interspersing distraction tests appeared to result in increased complexity and difficulty in coding and decoding information in patients with CP, leading to similar reliable long‐term memory consolidation in comparison with AP. Significance Treatments directed towards chronic pain should consider the influence of painful memories and their establishment towards long‐term explicit episodic memories in patients with chronic pain, as well as the influence of cognitive‐evaluative and affective‐motivational variables on memory. Not causing pain while implementing a treatment whose objective is to reduce pain could reduce the probability of developing new painful memories in patients with chronic pain.
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