The role of self-efficacy in chronic pain—A case report relating motivation during the COVID-19 pandemic and a patient with chronic pain.

RESEARCH OBJECTIVES: To analyze patient outcomes and traditional physical therapy interventions for chronic low back back, and discuss the benefits of incorporating self-efficacy techniques to improve patient independence. DESIGN: Retrospective case report. SETTING: Outpatient physical therapy setting. PARTICIPANTS: 48-year-old female with complaints of chronic low back pain that has increased significantly over the last six months due to the societal consequences of COVID-19. The patient's past medical history included mild arthritis of her spine. The medications she was using for pain included Naproxen, and the patient also found relief with Salonpas pain relief patches. INTERVENTIONS: 1. Trunk flexion AAROM, x 10 repetitions, by rolling swiss ball forward on plinth to promote a stretch of the lower back and eliminate fear of mobility. 2. interferential electrical stimulation to low back to decrease pain x 10 min 3. bilateral dynamic hip strengthening on hip abduction machine with 45#, 10 reps x 3 sets each 4. Functional training such as proper lifting mechanics, 5 repetitions of box lifting 5. physiological components aimed to improve self-efficacy MAIN OUTCOME MEASURES: 1.numerical pain rating scale 2. Modified Oswestry Low Back Pain Disability Questionnaire RESULTS: The patient's pain improved throughout the 6 weeks that she was seen at physical therapy. This is reflected on her scores on the NPRS. Her baseline pain rating was 9.5/10 and by 6 weeks her score decreased to 3/10. The patient also showed improvements on the Modified Oswestry Disability Index, as seen by a decrease from 42% disability to 10% disability. Improvements were seen in the patient's bed mobility, lumbar flexion AROM, bilateral hip strength, and lower abdominal strength. CONCLUSIONS: This case is an example of someone with chronic low back pain that prior to the pandemic, had enough self efficacy to manager her condition independently. Interventions during physical therapy focused on traditional manual and therapeutic exercise principles as well as physiological components aimed to improve her self-efficacy. AUTHOR(S) DISCLOSURES: I declare that I have no relevant or material financial interests that relate to the research described in this paper”

Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks

OBJECTIVES: Neck pain commonly accompanies recurrent headaches such as migraine, tension-type and cervicogenic headache. Neck pain may be part of the headache symptom complex or a local source. Patients commonly seek neck treatment to alleviate headache, but this is only indicated when cervical musculoskeletal dysfunction is the source of pain. Clinical presentation of reduced cervical extension, painful cervical joint dysfunction and impaired muscle function collectively has been shown to identify cervicogenic headache among patients with recurrent headaches. The pattern's validity has not been tested against the 'gold standard' of controlled diagnostic blocks. This study assessed the validity of this pattern of cervical musculoskeletal signs to identify a cervical source of headache and neck pain, against controlled diagnostic blocks, in patients with headache and neck pain. DESIGN: Prospective concurrent validity study that employed a diagnostic model building approach to analysis. SETTING: Hospital-based multidisciplinary outpatient clinic in Joliet, Illinois. PARTICIPANTS: A convenience sample of participants who presented to a headache clinic with recurrent headaches associated with neck pain. Sixty participants were enrolled and thirty were included in the analysis. OUTCOME MEASURES: Participants underwent a clinical examination consisting of relevant tests of cervical musculoskeletal dysfunction. Controlled diagnostic blocks of C2/C3-C3/C4 established a cervical source of neck pain. Penalised logistic regression identified clinical signs to be included in a diagnostic model that best predicted participants' responses to diagnostic blocks. RESULTS: Ten of thirty participants responded to diagnostic blocks. The full pattern of cervical musculoskeletal signs best predicted participants' responses (expected prediction error = 0.57) and accounted for 65% of the variance in responses. CONCLUSIONS: This study confirmed the validity of the musculoskeletal pattern to identify a cervical source of headache and neck pain. Adopting this criterion pattern may strengthen cervicogenic headache diagnosis and inform differential diagnosis of neck pain accompanying migraine and tension-type headache