A more global approach to musculoskeletal pain: Expressive writing as an effective adjunct to physiotherapy

Pepe, Luigi; Milani, R. V.; Trani, Michela Di; Folco, Gianluca Di; Lanna, Vittorio; Solano, Luigi

doi:10.1080/13548506.2013.859712

Cited by 18 publications

(6 citation statements)

References 24 publications

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“…Psychosocial risk factors include catastrophizing, fear avoidance, magnification, depression, and anxiety [30]. At-risk patients underwent education on expressive writing and cognitive behavioral techniques [31]. Group mindfulness classes were also encouraged in patients who were thought to exhibit psychosocial risk factors.…”

Section: Ipu Modelmentioning

confidence: 99%

In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model

Raiszadeh¹,

Tapicer²,

Taitano³

et al. 2021

J Med Internet Res

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Background The recent onset of the COVID-19 pandemic has highlighted the need to reduce barriers to access physical therapy and associated care through the use of web-based programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared the effectiveness of clinic-based versus web-based or telehealth services. Objective This study aims to compare the clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit (C-IPU) model with online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP. Methods A total of 1090 participants were prospectively recruited to participate in a clinical trial registry (NCT04081896) through the SpineZone rehabilitation IPU program. All participants provided informed consent. Participants were allocated to the C-IPU (N=988) or O-IPU (N=102) groups based on their personal preferences. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist-directed home core strengthening exercises through a web-based platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient-Specific Functional Scale), and frequency of opioid use were compared between the C-IPU and O-IPU groups using multivariate linear regression modeling adjusted for age, gender, treatment number, program duration, and baseline pain and disability. Results Approximately 93.03% (1014/1090) of the participants completed their recommended programs, with no group differences in dropout rates (P=.78). The C-IPU group showed greater pain relief (P<.001) and reductions in disability (P=.002) than the O-IPU group, whereas the O-IPU group reported greater improvements in goal achievement (P<.001). Both programs resulted in reduced opioid use frequency, with 19.0% (188/988) and 21.5% (22/102) of participants reporting cessation of opioid use for C-IPU and O-IPU programs, respectively, leaving only 5.59% (61/1090) of participants reporting opioid use at the end of their treatment. Conclusions Both in-clinic and web-based multidisciplinary programs are beneficial in reducing pain, disability, and opioid use and in improving goal achievement. The differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs. Trial Registration ClinicalTrials.gov NCT04081896; https://clinicaltrials.gov/ct2/show/NCT04081896

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Section: Ipu Modelmentioning

confidence: 99%

In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model

Raiszadeh¹,

Tapicer²,

Taitano³

et al. 2021

J Med Internet Res

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“…To address the impact of unresolved stressful life experiences or psychological conflicts on chronic pain, we and others have tested whether reversing emotional avoidance or inhibition by privately writing or speaking about stressors will reduce pain. Trials of expressive writing or emotional disclosure have found mixed results: there have been inconsistent, often null effects for people with rheumatoid arthritis (68)(69)(70)(71)(72)(73), but some benefits for those with FM (74,75), pelvic pain (76), and musculoskeletal pain (77,78). Our review of this literature concluded that these techniques may be more helpful in patients with centralized pain than those with nociceptive pain conditions, such as rheumatoid arthritis, perhaps because of the higher levels of life stress and emotional problems in patients with centralized pain compared to RA (79).…”

Section: Expressive Writing / Emotional Disclosurementioning

confidence: 99%

Psychological Therapy for Centralized Pain: An Integrative Assessment and Treatment Model

Lumley

Schubiner

2019

Psychosom Med

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Objective: Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed. Methods:We briefly review the leading evidence-based psychological therapies for chronic pain -cognitive-behavioral and acceptance / mindfulness-based therapies-and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges.Results: Greater pain treatment efficacy may be possible if clinicians: a) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; b) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; c) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and d) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress. Conclusions:This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.

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“…Hence, the right thing to do might be to seek how to best combine the two paradigms in a way that maximizes the expected positive effects. Working on an integrative approach is relevant as a very recent study on chronic pain patients showed greater efficiency of physiotherapy when combined with expressive writing (Pepe et al, 2014). Our first results thus pave the way for addressing numerous variations and/or additional issues in future research on emotional disclosure.…”

Section: Discussionmentioning

confidence: 99%

Lexical Profile of Emotional Disclosure in Socially Shared Versus Written Narratives

Balon

Rimé

2016

Journal of Language and Social Psychology

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To disclose emotional experiences, people can either talk or write. Our research was intended to address content differences between social sharing of emotion and expressive writing. In the first study, 92 participants either talked to an experimenter or wrote alone about an emotional experience. In the second study, after watching an emotion-inducing film, 112 participants were asked to disclose their emotions by either writing, talking alone to a recorder, talking with an unknown peer, or talking with someone close to them. Computerised lexical analyses were conducted on all material collected with a central focus on affective and cognitive processes as well as on narrative style indices like personal pronouns. Consistently, results showed a higher proportion of emotion words in writing than in oral conditions. Personal pronoun use, emotional tone, and proportion of cognitive words also appeared to vary depending on disclosure mode and type of narrative target.

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A more global approach to musculoskeletal pain: Expressive writing as an effective adjunct to physiotherapy

Cited by 18 publications

References 24 publications

In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model

In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model

Psychological Therapy for Centralized Pain: An Integrative Assessment and Treatment Model

Lexical Profile of Emotional Disclosure in Socially Shared Versus Written Narratives

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