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Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
Work-Related Diseases, Finnish Institute of Occupational Health,.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0003-4753-6745
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2016 (English)In: SAGE open medicine, E-ISSN 2050-3121, Vol. 4, 2050312116668933Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments.

OBJECTIVES: (1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not.

METHOD: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4-6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not.

RESULTS: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial.

CONCLUSION: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise.

Place, publisher, year, edition, pages
2016. Vol. 4, 2050312116668933
Keyword [en]
Exercise, neck pain, psychological factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry Family Medicine
Identifiers
URN: urn:nbn:se:liu:diva-135743DOI: 10.1177/2050312116668933PubMedID: 27688880OAI: oai:DiVA.org:liu-135743DiVA: diva2:1082900
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2017-05-04
In thesis
1. Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes
Open this publication in new window or tab >>Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic pain is common in western countries and entails considerable consequences for the afflicted individuals as well as for the society. Furthermore, chronic pain is complex including an advanced interplay between biological-, psychological- and social aspects. Treatment of chronic pain attempts to decrease pain intensity and increase physical-, psychological- and social functioning. However, the treatment of chronic pain is still not optimized. Different types of physical activity and exercise (PA&E) are commonly applied as non-pharmacological treatment strategies for chronic pain, but the most efficient type and dose of PA&E are unclear. In addition, adherence to prescribed PA&E is often troublesome, which further complicates the application of PA&E as treatment for chronic pain.

The aim of this thesis is to increase the knowledge about PA&E as treatment for chronic pain regarding pain intensity, biochemical substances, adherence and attitudes.

The findings of this thesis were that a long-term, home-based PA&E intervention comprising strength exercises as well as stretch exercises decreased pain intensity and increased function in women with chronic neck- and shoulder pain. Using microdialysis technique, differences in pain modulatory biochemical substances were found, before the intervention, in painful trapezius muscle compared to pain-free trapezius muscle. In addition, alterations in pain modulatory substances in painful trapezius muscle after the intervention were found, which possibly could imply peripheral physiological effects of PA&E. Furthermore, psychological factors could be associated to the effects of and adherence to the PA&E intervention. An intention to be physically active were expressed by patients with chronic pain, but a discordance between the intention and PA&E-behaviour were evident, even though the PA&E were experienced as valuable.

In conclusion, this thesis strengthens the importance of PA&E as treatment for chronic pain. Especially, this thesis increases the knowledge about; possible peripheral pain inhibitory effects after long-term exercise; how psychological factors might affect the results of PA&E; and also about important behavioural aspects that might affect adherence to prescribed PA&E. This thesis highlights the need of more research on physiological pain inhibitory effects of long-term PA&E in chronic pain. Furthermore, improved methods for ensured adherence to prescribed PA&E are necessary in order to optimize the effect of PA&E as treatment for chronic pain.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1575
Keyword
Adherence, biochemical substances, chronic pain, physical activity and exercise, treatment
National Category
Physiotherapy Orthopedics Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-137076 (URN)10.3384/diss.diva-137076 (DOI)9789176855188 (ISBN)
Public defence
2017-06-02, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
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Supervisors
Available from: 2017-05-04 Created: 2017-05-04 Last updated: 2017-05-05Bibliographically approved

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