Explore the vast range of titles available.

Background Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? Methods A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the ‘Risk of Bias Tool for Prevalence Studies’, ‘COSMIN Risk of Bias checklist for Patient-reported outcome measures’, modified version of the ‘Appraisal Tool for Cross-sectional studies’, and the ‘Cochrane Risk of Bias 2’ tools for each research question, respectively. Results 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The ‘Falls Efficacy Scale – International’ (FES-I) and ‘Fear of Falling Questionnaire – Revised’ (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. Conclusion FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice. Trial registration PROSPERO registration: CRD42020221836.

aim: To synthesise the literature describing experiences of chronic pain and pain management for Māori, and to understand how this experience could inform service delivery and clinical practice. method: We systematically searched for qualitative research on Māori chronic pain experiences (Scopus, Medline, APA PsycINFO, NZ Research, Research Square). Data extracted were coded and synthesised using thematic analysis. results: Seven studies were included. Three themes encapsulated the data: 1) a multidimensional view of pain and pain management: Māori expressed a holistic and integrated understanding of the multiple factors that influence pain and its management, 2) a responsibility: respectful tikanga-informed care: the experiences of Māori participants with healthcare highlight a need for antiracist approaches, and a clinical responsibility to practice manaakitanga and tikanga, and 3) tino rangatiratanga: a desire for knowledge, choice and autonomy in pain management: Māori valued the empowering nature of knowledge about pain, and information and support to make decisions about treatment, including considerations regarding Western and traditional Māori medicine. conclusion: Health services need to understand and respect the multidimensional aspects of pain, minimise racism and discrimination, use whakawhanaungatanga, manaakitanga, and tikanga-informed practices, and provide appropriate information to support tino rangatiratanga for pain management.

Little research has assessed the efficacy of interdisciplinary pain management programs (IPMPs) for complex regional pain syndrome (CRPS), whereas evidence shows that IPMPs are effective for low back pain (LBP) and chronic widespread pain (CWP). This study aimed to determine whether outcomes following an IPMP differ for people with CRPS compared to LBP and CWP. In addition, we determined whether it is possible to predict IPMP outcomes using baseline characteristics. People with CRPS (N = 66) who had completed a 3-week IPMP were compared with age- and gender- matched controls with LBP (N = 66) and CWP (N = 66). Measures of pain intensity, pain interference and psychological factors were extracted for pre- and post-program, and at 1, 6, and 12 months. Latent class analysis identified recovery trajectories for pain intensity and pain interference, and χ2 analyses assessed differences between diagnostic groups in recovery trajectories. Machine learning models were implemented to predict recovery trajectories from baseline scores. Two recovery trajectories for each dependent variable (pain interference and for pain intensity) were identified: Good responders and poorer responders. Following IPMPs, 37% of people belonged to a good responder recovery trajectory for pain interference, and 11% belonged to a good responder recovery trajectory for pain intensity. Recovery trajectories were similar across the three diagnostic groups (CRPS, LBP, CWP) for pain interference (χ2 = 1.8, P = .4) and intensity (χ = 0.2, P = .9). Modeling to predict outcomes correctly classified 69% of cases for pain interference and 88% of cases for pain intensity recovery trajectories using baseline scores. People with CRPS, LBP, and CWP experience similar benefits following an IPMP. This supports the use of IPMPs for people with CRPS.

This narrative review aims to explore the mental and physical well-being of partners of individuals living with chronic pain. Chronic pain not only affects those who suffer from it, but also significantly impacts the lives of their partners; however, the impacts on partners are not well recognised, despite extensive evidence indicating that their quality of life can be equally affected. This review synthesises current literature to identify the psychological and physical challenges faced by these partners, including increased stress, anxiety, depression, and the potential for developing chronic health conditions themselves. A search of Medline for “chronic pain” and “partner/spouse” from January 1990 to the present was performed, and relevant articles were selected for review. The main findings were that while partners often experience a range of negative physical and psychosocial impacts on their quality of life, dyadic coping strategies can mitigate these effects. This review underscores the importance of future research to develop targeted interventions that address the unique needs of this population, promoting better health outcomes and fostering resilience in the face of chronic pain.

Abstract Objective Complex regional pain syndrome (CRPS) is a complex and often poorly understood condition, and people with CRPS will have diverse beliefs about their symptoms. According to the self-regulation model, these beliefs (termed “illness perceptions”) influence health behaviors and outcomes. Previous studies have found that psychological factors influence CRPS outcomes, but few studies have investigated CRPS patients’ illness perceptions specifically. The present study examined whether illness perceptions were related to pain intensity and other relevant outcomes in people with CRPS. Methods In this cross-sectional study, 53 patients with CRPS (type 1 and type 2) completed questionnaires assessing illness perceptions, pain, disability, and psychological factors. Multiple regression analyses were used to determine whether illness perceptions were associated with pain intensity, disability, depression, and kinesiophobia, after controlling for possible covariates (including clinical and demographic factors, pain catastrophizing, and negative affect). Results Negative illness perceptions were associated with greater pain, disability, and kinesiophobia, but not depression. Specifically, attributing more symptoms to CRPS (more negative illness identity perceptions) was associated with greater pain intensity, and reporting a poorer understanding of CRPS (lower illness coherence scores) was associated with greater disability and kinesiophobia. Conclusions Patients with CRPS with more negative illness perceptions (particularly perceptions indicating a poor understanding of their condition) also experience greater pain, disability, and kinesiophobia. Future research could investigate whether altering CRPS patients’ illness perceptions influences clinical outcomes.

Opioid tapering is a complex process for both clinicians and patients with chronic pain. This qualitative study explored the experiences of Aotearoa New Zealand clinicians in managing opioids for patients with chronic non-cancer pain. Purposive and snowball sampling were used to interview nineteen health professionals including general practitioners (n=5), pain medicine specialists (n=5), addiction medicine specialists (n=4), pain fellows (n=3), addiction medicine registrar (n=1) and a pain nurse practitioner (n=1). Data were collected using a face-to-face focus group and fourteen individual interviews conducted via Zoom. The data were analysed using a Reflexive Thematic Analysis approach. Independent parallel coding was done by members of our research team, and the final themes were iteratively developed by mutual consensus. This qualitative study suggests that meaningful opioid tapering requires a patient-centred approach that considers the individual's unique sociopsychobiomedical context. Clinicians emphasised the importance of building trust, addressing fears, and tailoring tapering regimens to patients' needs and motivations. While opioid tapering is a complex process for all patients, participants acknowledged unique considerations for supporting people living in rural areas - Māori and Pasifika and their whānau (families and significant others) addressing social determinants of health. There were overwhelming accounts of clinician distress from all participants especially for rural general practitioners due to the lack of support, conflicting practices, limited resourcing, and time constraints. These findings call for a co-ordinated, multidisciplinary approach to opioid tapering that addresses systemic inequities and prioritises patient and clinician well-being.

Abstract Objective Chronic pain is a leading cause of disability in low- and middle-income countries; however, pain assessment tools have generally been developed and validated in high-income countries. This study examines the psychometric properties of a set of translated pain (and distress) questionnaires in Mongolia and documents the characteristics of people seeking treatment for chronic pain in Mongolia, compared with those in New Zealand, which is representative of high-income countries. Design Cross-sectional, observational. Setting Hospital-based pain treatment centers in New Zealand and Mongolia. Subjects People seeking treatment for chronic pain in Mongolia (N = 142) and New Zealand (N = 159). Methods The Brief Pain Inventory, the Depression Anxiety Stress Scale–21, the Pain Catastrophizing Scale, and the Pain Self-Efficacy Questionnaire were translated into Mongolian and administered to patients attending a hospital-based pain service. Questionnaires that were completed by patients in New Zealand were used for comparisons. Internal reliability, convergent validity, and factor structure were assessed in both groups. Results Patients in Mongolia were older and reported lower pain intensity, interference, and distress and higher pain self-efficacy than those in New Zealand. The translated questionnaires had good internal consistencies, and the relationships between pain variables were similar across both groups. The factor structure for the Pain Catastrophizing Scale was consistent across both groups, but this was not the case for the Brief Pain Inventory or the Depression Anxiety Stress Scale–21. Conclusions Findings indicate that some pain outcome measures may be appropriate for use in Mongolia and should be investigated in other low- and middle-income countries.

Background:The modern management of chronic pain is largely focused on improving functional capacity (often despite ongoing pain) by using graded activation and exposure paradigms. However, many people with chronic pain find functional activation programs aversive, and dropout rates are high. Modern technologies such as virtual reality (VR) could provide a more enjoyable and less threatening way for people with chronic pain to engage in physical activity. Although VR has been successfully used for pain relief in acute and chronic pain settings, as well as to facilitate rehabilitation in conditions such as stroke and cerebral palsy, it is not known whether VR can also be used to improve functional outcomes in people with chronic pain.Objective:This study aimed to assess the feasibility of conducting an adequately powered randomized controlled trial (RCT) to test the efficacy of VR in a chronic pain treatment center and assess the acceptability of an active VR treatment program for patients in this setting.Methods:For this mixed methods pilot study, which was designed to test the feasibility and acceptability of the proposed study methods, 29 people seeking treatment for chronic pain were randomized to an active VR intervention or physiotherapy treatment as usual (TAU). The TAU group completed a 6-week waitlist before receiving standard treatment to act as a no-treatment control group. The VR intervention comprised twice-weekly immersive and embodied VR sessions using commercially available gaming software, which was selected to encourage movement. A total of 7 VR participants completed semistructured interviews to assess their perception of the intervention.Results:Of the 99 patients referred to physiotherapy, 53 (54%) were eligible, 29 (29%) enrolled, and 17 (17%) completed the trial, indicating that running an adequately powered RCT in this setting would not be feasible. Despite this, those in the VR group showed greater improvements in activity levels, pain intensity, and pain interference and reported greater treatment satisfaction and perceived improvement than both the waitlist and TAU groups. Relative effect sizes were larger when VR was compared with the waitlist (range small to very large) and smaller when VR was compared with TAU (range none to medium). The qualitative analysis produced the following three themes: VR is an enjoyable alternative to traditional physiotherapy, VR has functional and psychological benefits despite continued pain, and a well-designed VR setup is important.Conclusions:The active VR intervention in this study was highly acceptable to participants, produced favorable effects when compared with the waitlist, and showed similar outcomes as those of TAU. These findings suggest that a confirmatory RCT is warranted; however, substantial barriers to recruitment indicate that incentivizing participation and using a different treatment setting or running a multicenter trial are needed.

Abstract Objective Complex regional pain syndrome (CRPS) is a painful limb condition known to cause significant disability and distress. However, little previous research has explored CRPS from a patient perspective. The present qualitative study aimed to describe the experiences of people living with CRPS. Subjects Forty-eight people with CRPS participated in this research. Methods Participants completed a face-to-face or telephone interview about their perceptions and experiences of CRPS and completed three drawings to illustrate their experiences. Data were analyzed through reflexive thematic analysis, and images in drawings were grouped and coded by theme. Results Three overarching themes encapsulated the data, including that 1) people experience CRPS as a source of severe symptoms and emotional difficulties, 2) CRPS undermines personal and social identity, and 3) this results in psychological responses that protect against the emotional and social impact of severe symptoms. Psychological responses include: a) searching for an explanation, b) “nothing is my fault,” emphasizing a lack of personal responsibility and personal control, and c) detaching the limb from the self. Conclusions CRPS is experienced as highly threatening to physical ability, psychological state, and identity. In response to these threats, people may develop their own explanations for CRPS and may mentally detach themselves from responsibility, control, and the painful limb itself. Future research could explore the impact of these factors on psychological well-being and CRPS symptoms and outcomes.