Do threats and reassurances reside in the biological, psychological or social domain? A qualitative study in adults and young people with chronic pain.

Objective: Understanding biopsychosocial contributions to a sensitised pain system is a key target of many pain management programs. The 'Protectometer' is a freely available educational tool that guides people with chronic pain to explore their personal threats and reassurances, identifying them as 'DIMs' (danger in me) or 'SIMs' (safety in me), to guide personalised pain management. This study aimed to explore common types of DIMs and SIMs, and examine differences between adults and young people.

A comparison of visual and direct assessments of lumbar spine posture.

Background: Posture is assessed clinically and used to guide treatment of low back pain. Collectively, the relevance of posture and clinical postural assessments have come under scrutiny. This study aimed to determine (a) the intra-rater and inter-rater reliability of visual assessments of lumbar lordosis, and (b) the agreement between visual and direct postural assessments.

Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals With Persistent Low Back Pain.

Objectives: To evaluate the effect of combining pain education and virtual reality (VR) exposure therapy using a cognitive-behavioral therapy-informed approach (virtual reality-based cognitive behavioral therapy [VR-CBT]) on pain intensity, fear of movement, and trunk movement in individuals with persistent low back pain.

Materials And Methods: Thirty-seven participants were recruited in a single cohort repeated measures study, attending 3 sessions 1 week apart. The VR-CBT intervention included standardized pain education (session 1) and virtual reality-based exposure therapy (VRET; session 2) incorporating gameplay with mixed reality video capture and reflective feedback of performance.

The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol.

Background: Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect.

Immersive virtual reality gameplay detects visuospatial atypicality, including unilateral spatial neglect, following brain injury: a pilot study.

Background: In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries.

Methods: In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game.

Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies.

Since it emerged in the early 2000's, intensive education about 'how pain works', widely known as pain neuroscience education or explaining pain, has evolved into a new educational approach, with new content and new strategies. The substantial differences from the original have led the PETAL collaboration to call the current iteration 'Pain Science Education'. This review presents a brief historical context for Pain Science Education, the clinical trials, consumer perspective, and real-world clinical data that have pushed the field to update both content and method.

Could Vulnerability to Motion Sickness and Chronic Pain Coexist within a Sensorimotor Phenotype? Insights from over 500 Pre-Pain Motion Sickness Reports.

Background: The sensorimotor incongruence theory proposes that certain instances of pain result from conflicts in the brain's sensorimotor networks. Indeed, injuries may cause abnormalities in afferent and cortical signaling resulting in such conflicts. Motion sickness also occurs in instances of incongruent sensorimotor data.

A randomized controlled pilot study examining immediate effects of embodying a virtual reality superhero in people with chronic low back pain.

Purpose: In virtual reality, avatar embodiment can spur perceptions and behaviours related the avatars' characteristics. We tested whether embodying superhero-like avatars can change self-perceptions in people with chronic low back pain (CLBP).

Design: A non-blinded pilot randomized controlled trial.

Key Learning Statements for Persistent Pain Education: An Iterative Analysis of Consumer, Clinician and Researcher Perspectives and Development of Public Messaging.

Over the last decade, the content, delivery and media of pain education have been adjusted in line with scientific discovery in pain and educational sciences, and in line with consumer perspectives. This paper describes a decade-long process of exploring consumer perspectives on pain science education concepts to inform clinician-derived educational updates (undertaken by the authors). Data were collected as part of a quality audit via a series of online surveys in which consent (non-specific) was obtained from consumers for their data to be used in published research.

"It made you feel like you've still got it": experiences of people with chronic low back pain undertaking a single session of body image training in virtual reality.

Introduction: Embodying fit avatars in virtual reality (VR) is proposed as a possible treatment for cortical body representations and pain-related self-perceptions.

Objective: To explore consumer perceptions of a novel VR intervention (VR-BiT) for chronic low back pain.

Methods: Adults (n = 17, mean age(SD) = 52(14)) with chronic low back pain who had undergone a single session of VR-BiT as part of a randomized controlled trial underwent a semi-structured interview using open-ended questions.

Visually evoked pain and its extinction using virtual reality in a patient with complex regional pain syndrome type II.

In this case report, we used virtual reality (VR) to explore pain evoked by only the appearance of being touched (rather than actually being touched) in a person with complex regional pain syndrome type II. Furthermore, we explored the degree to which this visually evoked pain could be extinguished by applying exposure principles in VR. In stage 1, we identified 4 specific scenarios where pain was triggered by visually simulated touch (without physical stimulation) and used these scenarios to quantify baseline sensitivity to visuotactile stimulation.

Classically conditioned modulation of pain depends on stimulus intensity.

Innocuous cues that become associated with pain can enhance pain. This is termed classically conditioned hyperalgesia. The size of this effect varies under different conditions.

Modernising tactile acuity assessment; clinimetrics of semi-automated tests and effects of age, sex and anthropometry on performance.

Background: Reduced tactile acuity has been observed in several chronic pain conditions and has been proposed as a clinical indicator of somatosensory impairments related to the condition. As some interventions targeting these impairments have resulted in pain reduction, assessing tactile acuity may have significant clinical potential. While two-point discrimination threshold (TPDT) is a popular method of assessing tactile acuity, large measurement error has been observed (impeding responsiveness) and its validity has been questioned.

The iSTOPP study: Protocol for a proof-of-concept randomised clinical trial of sensory discrimination training in people with persistent neck pain.

Background: Neck pain can be associated with a reduction in tactile acuity that is thought to reflect disrupted sensory processing. Tactile acuity training may normalise sensory processing and improve symptoms. This proof-of-concept trial will assess the feasibility of a novel tactile acuity training method and whether this intervention improves tactile acuity in people with persistent neck pain.

Psycho-sensory relationships in chronic pain.

Background: Psychological variables contribute to pain- and injury-related outcomes. We examined the hypothesis that anatomical spread and intensity of persistent pain relate to anxiety-related variables: generalised anxiety, fear of pain and pain catastrophising.

Methods: An online survey was used to gather data from 413 women with persistent pain (low back pain, n = 139; fibromyalgia syndrome, n = 95; neck pain, n = 55; whiplash, n = 41; rheumatoid arthritis, n = 37; migraine, n = 46).

Description and psychometric properties of a prototype to test tactile acuity in the neck.

Background: Clinical tools assessing tactile acuity in people with persistent pain have limitations. Therefore, a novel and semi-automated tool was developed: The Imprint Tactile Acuity Device (iTAD).

Aim: To describe the iTAD prototype and present the psychometric properties of its tactile acuity assessments: the localisation test, the orientation test and the overall score (mean of both tests).

Learning to predict pain: differences in people with persistent neck pain and pain-free controls.

Background: Learning to predict threatening events enables an organism to engage in protective behavior and prevent harm. Failure to differentiate between cues that truly predict danger and those that do not, however, may lead to indiscriminate fear and avoidance behaviors, which in turn may contribute to disability in people with persistent pain. We aimed to test whether people with persistent neck pain exhibit contingency learning deficits in predicting pain relative to pain-free, gender-and age-matched controls.

Illusion-enhanced Virtual Reality Exercise for Neck Pain: A Replicated Single Case Series.

Objectives: Body illusions have shown promise in treating some chronic pain conditions. We hypothesized that neck exercises performed in virtual reality (VR) with visual feedback of rotation amplified would reduce persistent neck pain.

Methods: In a multiple-baseline replicated single case series, 8 blinded individuals with persistent neck pain completed a 4-phase intervention (initial n=12, 4 dropouts): (1) "baseline"; (2) "VR" during which participants performed rotation exercises in VR with no manipulation of visual feedback; (3) "VR enhanced" during which identical exercises were performed but visual feedback overstated the range of motion being performed; (4) "follow-up.

A biomechanical analysis of the stand-up paddle board stroke: a comparative study.

Background: Stand-up paddle boarding (SUP) is a rapidly growing global aquatic sport, with increasing popularity among participants within recreation, competition and rehabilitation. To date, few scientific studies have focused on SUP. Further, there is no research examining the biomechanics of the SUP paddle stroke.

Pain Education for Adolescents and Young Adults Living Beyond Cancer: An Interdisciplinary Meeting Report.

Pain is an understudied and undertreated consequence of cancer survival. Pain education is now a recommended treatment approach for persistent non-cancer pain, yet it has not been well applied to the context of adolescent and young adult (AYA) cancer survival. In March 2018, an interdisciplinary meeting was held in Adelaide, South Australia to set a research agenda for pain education in AYA cancer survivors.

Distorted distance perception to reachable points in people with chronic shoulder pain.

Perception is not simply a carbon copy of the real world, but is subject to distortions that may reflect protective drive. This study aimed to investigate whether people with chronic shoulder pain show perceptual distortions of space and body that may promote protective behavior. Eighty-four people with shoulder pain and 51 healthy controls participated.

Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

Background: Low back pain is responsible for significant personal and societal burden, particularly when it becomes persistent. Despite international consensus regarding the judicious use of diagnostic spinal imaging, patients continue to be over-referred.

Objective: The aim of this article is to highlight the critical need for primary care clinicians to engage in thoughtful use of imaging procedures, and to consider alternative or adjunct methods for providing reassurance, in order to avoid or mitigate the potential negative impact of 'anomalous' findings.

Do pain-associated contexts increase pain sensitivity? An investigation using virtual reality.

Background and aims Pain is not a linear result of nociception, but is dependent on multisensory inputs, psychological factors, and prior experience. Since nociceptive models appear insufficient to explain chronic pain, understanding non-nociceptive contributors is imperative. Several recent models propose that cues associatively linked to painful events might acquire the capacity to augment, or even cause, pain.

Tactile acuity is reduced in people with chronic neck pain.

Background: Tactile acuity deficits have been demonstrated in a range of persistent pain conditions and may reflect underlying cortical re-organisation.

Objective: This study aimed to determine whether tactile acuity is impaired in people with chronic neck pain relative to controls, and whether deficits relate to pain location, duration and intensity.

Methods: In this cross-sectional study, 20 people with chronic neck pain (5 idiopathic neck pain; 15 whiplash-associated disorder) and 20 pain-free controls underwent two-point discrimination (TPD) testing at the neck, back and arm, and point-to-point (PTP) and graphesthesia tests of tactile acuity at the neck and arm.