To compare the pain-reducing effect of forest bathing alone versus forest bathing in combination with stretching and strengthening exercises in patients with chronic posterior neck pain.
Sixty-four subjects with posterior neck pain that had lasted more than 3 months were enrolled. They were randomly divided into a forest bathing alone (FBA) group and a forest bathing with exercise (FBE) group; each group included 32 subjects. All subjects from both groups walked every morning in the forest for about 2 hours for 5 days. In the afternoon, the FBE group did a stretching and strengthening exercise for about 4 hours; the FBA group had free time in the woods. Visual analog scale (VAS) on one day, VAS over the previous week, neck disability index (NDI), EuroQol 5D-3L VAS (EQ VAS) and index (EQ index), McGill pain questionnaire (MPQ), the number of trigger points in the posterior neck region (TRPs), and the range of motion of the cervical spine were evaluated on the first and last day of the program and compared between the two groups.
The number of TRPs were significantly reduced in the FBE group compared with the FBA group (p=0.013). However, the other scales showed no significant difference between the two groups.
When patients with chronic posterior neck pain underwent a short-term forest bathing (less than 7 days) program, FBE was more effective in the reduction of the number of TRPs than FBA. However, all other pain measurement scales we evaluated showed no statistically significant difference between the two protocols.
Citations
To investigate the relationship of the patient's criteria of successful treatment to emotional factors in patients with chronic musculoskeletal pain.
Patients who visited our outpatient hospital due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Patients were evaluated with the Patient-Centered Outcomes Questionnaire (PCOQ) to investigate their expectation and criteria for success regarding treatment of chronic musculoskeletal pain. Beck Depression Inventory and State-Trait Anxiety Inventory were used to check for psychological variables. Correlations among each of the variables were evaluated statistically.
Patients with higher levels of depression and anxiety needed larger improvements to consider the treatment as a success in the pain domain (depression, r=0.398, p=0.04; anxiety, r=0.447, p=0.02) and emotional distress domain (depression, r=0.617, p=0.001; anxiety, r=0.415, p=0.03), but had lower level of expectation of the treatment in the pain domain (depression, r=-0.427, p=0.01; anxiety, r=-0.441, p=0.004), emotional distress domain (depression, r=-0.454, p=0.01; anxiety, r=-0.395, p=0.04), and interference of daily activities domain (depression, r=-0.474, p=0.01; anxiety, r=-0.396, p=0.04). Patients were classified into 3 clusters based on the importance rating of each domain via a hierarchical analysis. The cluster of the patients with the higher rating of importance across all domains (importance of pain domain, 9.54; fatigue domain, 9.08; emotional distress domain, 9.23; interference of daily activities domain, 9.23) had the highest level of depression and anxiety.
Consideration of psychological factors, especially in patients who require larger improvements in all treatment domains, may be helpful for the successful treatment of chronic musculoskeletal pain.
Citations
To investigate the analgesic effect of transcranial direct current stimulation (tDCS) over the primary motor (M1), dorsolateral prefrontal cortex (DLPFC), and sham tDCS in patients with painful diabetic polyneuropathy (PDPN).
Patients with PDPN (n=60) were divided randomly into the three groups (n=20 per group). Each group received anodal tDCS with the anode centered over the left M1, DLPFC, or sham stimulation for 20 minutes at intensity of 2 mA for 5 consecutive days. A blinded physician rated the patients' pain using a visual analog scale (VAS), Clinical Global Impression (CGI) score, anxiety score, sleep quality, Beck Depression Inventory (BDI), and the pain threshold (PT) to pressure.
After the tDCS sessions, the M1 group showed a significantly greater reduction in VAS for pain and PT versus the sham and DLPFC groups (p<0.001). The reduction in VAS for pain was sustained after 2 and 4 weeks of follow-up in the M1 group compared with the sham group (p<0.001, p=0.007). Significant differences were observed among the three groups over time in VAS for pain (p<0.001), CGI score (p=0.01), and PT (p<0.001). No significant difference was observed among the groups in sleep quality, anxiety score, or BDI score immediately after tDCS.
Five daily sessions of tDCS over the M1 can produce immediate pain relief, and relief 2- and 4-week in duration in patients with PDPN. Our findings provide the first evidence of a beneficial effect of tDCS on PDPN.
Citations
Objective: To evaluate the effect of chronic pain on psychosocial functions in adults with athetoid cerebral palsy.
Method: Thirty-five adults with athetoid cerebral palsy were recruited as subjects, then the radiologic and electrodiagnostic studies were assessed. The characteristics of pain in severity and disability status with Von Korff's chronic pain grade classification system and psychosocial functional status using affect balance scale, Beck depression inventory, social adjustment scale and satisfaction with life scale were evaluated.
Results: Twenty-eight (80.0%) subjects had the pain lasting more than 3 months. The mean score of characteristic pain intensity was 65.5⁑11.5. Eleven subjects (31.4%) showed both abnormal radiologic and electrodiagnostic findings, and these subjects had higher disability score among the subjects who complaint of chronic pain (p＜0.05). The pain intensity had significant relationship with negative affects such as depression and dissatisfaction with life style (p＜0.05). In addition, social adjustment tended to be lower in subjects with severe chronic pain.
Conclusion: Chronic pain was commonly observed in adults with athetoid cerebral palsy, and the pain adversely affected psychosocial functions. Therefore, proper management of chronic pain might be helpful for enhancing their psychosocial functions in these subjects. (J Korean Acad Rehab Med 2002; 26: 391-397)
Objective: To investigate the influence of psychologic factors and stress on chronic pain syndrome and predictive factors of chronic pain.
Method: The subjects were 23 patients with chronic pain. The age was ranged from 25 to 66 years with an average of 45. We measured pain with initial visual analogue scale (VAS), one-week total VAS, and tenderness threshold by pressure algometer. We evaluated the degree of depression, anxiety and disability with chronic pain and the impact of stress of major versus minor daily events. Association between degree of pain and psychologic factors was studied by regression and stress of major versus minor daily events by correlation analysis. Predictive factors for chronic pain were determined by multiple regression analysis. Association of daily fluctuation of pain severity and stress from minor life events was also studied.
Results: One-week total VAS was associated with initial VAS (r=0.601, p＜0.05). Initial VAS had association with depression and anxiety. Predictive factors for one-week total VAS were initial VAS, static anxiety, and pain disability (r=0.624, p＜0.05).
Conclusion: Depression, anxiety, pain disability from chronic pain, and stress were major influencing factors in patients with chronic pain.
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