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PubMed2000

Interventions for preventing ankle ligament injuries.

BACKGROUND: Some sports, for example basketball and soccer, have a very high incidence of ankle injuries, mainly sprains. This contributes to ankle sprains being one of the most commonly treated injuries. OBJECTIVES: To assess the effects of interventions used for the prevention of ankle ligament injuries or sprains in physically active individuals from adolescence to middle age. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1966 to July 1996), EMBASE (1980 to September 1996), CINAHL (1982 to June 1996), and bibliographies of study reports. We also contacted colleagues and some trialists. Date of the most recent search: March 1997. SELECTION CRITERIA: Randomised or quasi-randomised trials of interventions for the prevention of ankle sprains in physically active individuals from adolescence to middle age were included provided ankle sprains were recorded. Interventions include use of modified footwear and associated supports, adapted training programmes and health education. DATA COLLECTION AND ANALYSIS: At least four reviewers independently assessed methodological quality and extracted data. Wherever possible, results of outcome measures were pooled and sub-grouped by history of previous sprain. MAIN RESULTS: Five randomised trials with data for 3954 participants were included. All trials involved young, active, mostly male adults participating in high-risk, usually sporting, activities. With the exception of ankle disc training, all prophylactic interventions entailed the application of an external ankle support in the form of a semi-rigid orthosis, air-cast brace or high top shoes. There was a significant reduction in the number of ankle sprains in people allocated external ankle support (Peto odds ratio 0.49; 95% confidence interval 0.37 to 0.66). This reduction was greater for those with a previous history of ankle sprain, but still possible for those without prior sprain. There was no apparent difference in the degree of severity of the ankle sprain prevented nor any change to the incidence of other leg injuries. The protective effect of 'high-top' shoes remains to be established. There was limited evidence for reduction in ankle sprain for those with previous ankle sprains who did ankle disc training exercises. REVIEWER'S CONCLUSIONS: This review provides good evidence for the beneficial effect of ankle supports in the form of semi-rigid orthoses or air-cast braces to prevent ankle sprain during high-risk sporting activities (e.g. soccer, basketball). Participants with a history of previous sprain can be advised that wearing such supports may reduce the risk of incurring a future sprain. However, any potential prophylactic effect should be balanced against the baseline risk of the activity, the supply and cost of the particular device, and for some, the possible or perceived loss of performance. Further research is indicated principally to investigate other prophylactic interventions and general applicability.

Adolescent↗

PubMed2001

Contractures in orthopaedic and neurological conditions: a review of causes and treatment.

PURPOSE: To examine the techniques used for the treatment of contracture in the context of current scientific knowledge of muscle. METHOD: Synthesis of data available from MEDLINE, RECAL, EMBASE, the Cochrane Library and relevant texts. RESULTS: The development of contractures through immobilisation, muscle weakness and spasticity is described. The effects of passive stretching, continuous passive movement, serial plastering, splinting, electrical stimulation, botulinum injections and surgical tenotomies in the treatment of contractures in persons with neurological and orthopaedic conditions are identified. The strengths and weaknesses of these modalities are discussed. CONCLUSION: Predisposing factors persist after treatment of contractures thus for treatment to be effective long-term management programmes need to be developed. New treatment techniques, used in series or combined, offer the prospect of improved management of contracture. Scientific and clinical research is needed to investigate the effect of contracture treatment.

Activities of Daily Living↗

PubMed1995

Effect of vertical loading on energy cost and kinematics of running in trained male subjects.

This investigation examined, in a group of 10 trained male runners, the effect of vertical loading during level treadmill running at a velocity of 5 m/s. The net energy cost of running (Cr), the external work of the center of mass of the body (Wext; both expressed in J.kg-1.m-1), and the eccentric-to-concentric ratio (Ecc/Con) of integrated electromyographic activity for the vastus lateralis (VL) and gastrocnemius lateralis muscles were measured. It was observed that Wext and Ecc/Con for the VL could explain a large part of the interindividual variations in Cr. This result reinforces the hypothesis that Ecc/Con could be a good index of effectiveness in the stretch-shortening cycle. When the subjects ran with a vertical load of 9.3% of their body mass, Cr and Wext were significantly reduced (P < 0.01 and P < 0.05, respectively), whereas Ecc/Con for the VL and gastrocnemius lateralis remained unchanged. The variations in Cr and Wext due to vertical loading were significantly correlated (r = 0.75; P < 0.01). It was then concluded that the significant improvement of Cr observed with the added load was mainly due to the fact that Wext was significantly decreased.

Adult↗

PubMed1984

Flexibility development in sprinters using EMG biofeedback and relaxation training.

This study compared the effectiveness of electromyographic (EMG) biofeedback and relaxation treatment in producing flexibility increases at the hip joint. Retention of flexibility gains and changes in sprinting performance were also examined. Fifteen male and 15 female athletes, predominantly sprinters, were matched according to age, sex, and flexibility and were randomly assigned to one of three groups. The control group received only the testing, the biofeedback group received visual and auditory EMG training, and the relaxation group received modified PMR and imagery exercises. Subjects in the two experimental groups were given eight twice-weekly 10-minute sessions and then were retested for flexibility. Retention of flexibility was reassessed 2 and 4 weeks later. Sprint performance improved for all groups. EMG biofeedback and relaxation treatment methods were no more effective than stretching exercises used by the control group for improving flexibility during the treatment period, but they did produce evidence of superior flexibility gains in the retention period. This may be important as flexibility has been reported to be related to the incidence of injuries.

Adolescent↗

PubMed1999

Oxidants and skeletal muscle function: physiologic and pathophysiologic implications.

Previous studies have demonstrated that skeletal muscles generate considerable reactive oxygen during intense muscle contraction. However, the significance of this phenomenon and whether it represents normal physiology or pathology are poorly understood. Treatment with exogenous antioxidants suggests that normal redox tone during contraction is influencing ongoing contractile function, both at rest and during intense exercise. This could represent the influence of redox-sensitive proteins responsible for excitation-contraction coupling or redox-sensitive metabolic enzymes. Some conditions associated with intense exercise, such as local tissue hypoxia or elevated tissue temperatures, could also contribute to reactive oxygen production. Evidence that muscle conditioning results in upregulation of antioxidant defenses also suggests a close relationship between reactive oxygen and contractile activity. Therefore, there appears to be a significant role for reactive oxygen in normal muscle physiology. However, a number of conditions may lead to an imbalance of oxidant production and antioxidant defense, and these, presumably, do create conditions of oxidant stress. Ischemia-reperfusion, severe hypoxia, severe heat stress, septic shock, and stretch-induced injury may all lead to oxidant-mediated injury to myocytes, resulting in mechanical dysfunction.

Animals↗

PubMed2006

Acute effects of static stretching on peak torque and mean power output in National Collegiate Athletic Association Division I women's basketball players.

The purpose of this study was to examine the acute effects of static stretching on peak torque (PT) and mean power output (MP) during maximal, voluntary concentric isokinetic leg extensions at 60 and 300 degrees .s(-1) in National Collegiate Athletic Association Division I Women's Basketball players. Eleven members of a women's basketball team volunteered to perform maximal concentric isokinetic leg extensions at 60 and 300 degrees .s(-1) on a calibrated Biodex System 3 dynamometer. After the initial isokinetic testing, the dominant leg extensors were stretched using 1 unassisted and 3 assisted static stretching exercises. The poststretching isokinetic assessments were repeated at 5, 15, 30, and 45 minutes after the static stretching (post-5, post-15, post-30, and post-45). PT (N.m) and MP (W) were recorded by dynamometer software. The results indicated no stretching-related changes in PT (p = 0.161) or MP (p = 0.088) from pre- to poststretching for any of the testing intervals (post-5, post-15, post-30, and post-45). These findings indicated that the static stretching had no impact on PT or MP during maximal, voluntary concentric isokinetic muscle actions in collegiate women's basketball players. In conjunction with previous studies, these findings suggested that trained athletes may be less susceptible to the stretching-induced force deficit than untrained, nonathletes.

Adult↗

PubMed2001

Nocturnal leg cramps. Clinically mysterious and painful--but manageable.

Nocturnal leg cramps are common occurrences among older, generally healthy adults. Although there are many known causes--endocrinologic, neurologic, and vascular disorders, treatment with certain drugs, and occupational factors--a significant portion of cases are idiopathic. History, physical exam, and laboratory testing can provide clues for distinguishing between cramps with identifiable causes and idiopathic cases. For nonidiopathic cases, management consists of treating the underlying cause whenever possible. A nonpharmacologic approach (massaging and stretching) is the recommended first-line treatment for idiopathic cases. Quinine sulfate also appears to offer safe and effective symptom management of idiopathic cases, although its efficacy has not been definitively established in clinical trials.

Age Distribution↗

PubMed1996

[Traumatological risk in ambulatory cardiological rehabilitation].

BACKGROUND: In Israel in 1956 Gottheiner introduced outpatient rehabilitation programs in patients who had survived a myocardial infarction. In Germany one decade later these WHO phase III activities were established as well. At present any patient with cardiovascular disease is included unless suffering from acute illnesses or presenting with symptoms at rest. Gymnastics, stretching and the "historic" volleyball are completed by jogging, soccer, basketball and anaerobic exercise. Thus, a notable trauma rate would be expected especially in the elderly and those who are on anticoagulation. METHODS: A retrospective analysis evaluated questionnaires of 903 patients in 116 outpatient coronary care groups covering approximately equal to 270,000 patient exercise hours. RESULTS: 101 of 123 injuries (approximately equal to 1/2 200 patient exercise hours) occurred during games the majority of which having been distortions (53.7%), hematomas, or bruises (15.4%). Severe traumas included bone fractures (11.4%) and ruptured muscles, tendons, or ligaments (12.2%). One patient lost the sight of one eye due to a broken spectacle frame. Patients who had felt exercise as too exhausting (p < 0.001) or complained of cardiovascular symptoms (p < 0.01) showed a significantly elevated trauma rate. CONCLUSIONS: Thus, in outpatient cardiac rehabilitation the trauma rate is within the range of healthy sports men. To prevent injuries sports should be limited to the patient's level of activity. Improved skills in techniques and strategies as well as unbreakable glasses are recommended.

Aged↗

PubMed1994

Central cholinergic modulation of the exercise pressor reflex in anesthetized cats.

Effects of central administration of a cholinesterase inhibitor, physostigmine, on cardiovascular responses to static contraction and passive stretch of the triceps surae were studied using anesthetized cats. Contraction increased mean arterial pressure (MAP), heart rate (HR), and renal sympathetic nerve activity (RSNA) by 44 +/- 5 mmHg, 18 +/- 1 beats/min, and 86 +/- 6%, respectively. MAP, HR, and RSNA increased during stretch by 44 +/- 5 mmHg, 15 +/- 1 beats/min, and 61 +/- 4%, respectively. Administration of physostigmine (100 micrograms; 5 microliters) into the third ventricle decreased resting MAP by 22 +/- 3 mmHg and RSNA by 32 +/- 4%, with no effect on HR. Physostigmine attenuated the contraction-evoked responses as MAP, HR, and RSNA increased by 17 +/- 2 mmHg, 3 +/- 1 beats/min, and 31 +/- 6%, respectively. Also, physostigmine blunted MAP, HR, and RSNA responses to stretch (16 +/- 2 mmHg, 4 +/- 1 beats/min, and 9 +/- 6%, respectively). Posterior hypothalamic stimulation increased MAP by 39 +/- 3 mmHg, which was unaffected by physostigmine, despite a lower baseline. Cardiovascular and RSNA responses to contraction and stretch returned to control 90-120 min after physostigmine. Preadministration of the muscarinic antagonist, atropine sulfate (100 micrograms; 5 microliters), blocked the effects of physostigmine. Results suggest central cholinergic stimulation can inhibit the exercise pressor reflex in anesthetized cats.

Anesthesia↗

PubMed1989

The importance of pelvic tilt in reducing compressive stress in the spine during flexion-extension exercises.

An explanation for the importance of pelvic tilt exercises is proposed. This explanation derives from a mathematical model that predicts the existence of a relationship between lordosis (pelvic tilt) and the distribution of stresses within the spine. The model predicts that, for every angle of forward flexion, there is a unique degree of lordosis that will minimize and equalize the compressive stress within the spine. This stress-minimizing posture also is associated with the minimum muscular activity; the balance of the moment is supported by passive stretching of the connective tissues. These predictions were tested by comparing them with empirical values of spinal geometry and muscular activity, as measured simultaneously by an opto-electronic motion analysis and electromyographic (EMG) data collection system.

Exercise↗

PubMed2002

Etiology of the so-called "idiopathic scoliosis". Biomechanical explanation of spine deformity. Two groups of development of scoliosis. New rehabilitation treatment; possibility of prophylactics.

INTRODUCTION: Between various etiological factors of idiopathic scoliosis we also studied the biomechanical causes connected with the hip and pelvic regions. At all children with idiopathic scoliosis there is a real or functional abduction contracture of the right hip (sometimes plus flexions- and out-rotation contracture). The right hip abduction contracture is connected with "syndrome of contractures" at newborns and babies. MATERIAL: 629 children treated in University Pediatric Orthopaedic Department, Lublin/Poland were divided into two groups: *I group of development of scoliosis- 220 children aged from 4 to 10. Real abduction contracture of the right hip 4-6-8 degree, adduction of the left hip 35-40-45 degree. Rotation deformity, both scoliosis (Lumbar L and thoracic Th) at the same time. Progression. **II group of development of scoliosis - 409 children aged from 10-12 to 14. Adduction of the right hip 10-15 even 20 degrees, adduction of the left hip 35-40-45 degree. Lumbar left convex scoliosis, no rotation deformity or small, no thoracic scoliosis, or small, no progression or small. INFORMATION ABOUT "SYNDROME OF CONTRACTURES": Clinical symptoms of _syndrome of contractures" were described exactly by Mau and others. At scoliotic patients we see in the region of right hip the following tissues contracted and shortened: *tractus iliotibialis, *fascia lata, * fascias of m.gluteus medius and minimus, *m. sartorius, *m. rectus, *capsules of right hip joint. CLINICAL RESEARCH: Since 1980s we added the tests for the adduction of both hips in straight position of the joint to the standard examination of scoliotic patient. Depending on the value of adduction movements of both hips we divided all patients into two above mentioned groups (I and II). EVALUATION OF PRESENT REHABILITATION TREATMENT IN OUR MATERIAL:Children were divided into three groups depending on range of scoliosis: A. Scoliosis L 5 degrees - 10 degrees, Th 5 degrees - 10 degrees. These children did not perform (wrong!) extension exercises 10% B. Scoliosis L 15 degrees - 25 degrees, Th 15 degrees - 25 degrees. These children performed (wrong!) extension exercises 30% C. Scoliosis L 25 degrees - 35 degrees or more, Th 25 degrees - 35 degrees or more. Older children. Extension (wrong!) exercises long time (1-2-3 years!) 60% CONCLUSIONS: 1 . The so-called idiopathic scoliosis are connected with the right hip real or functional abduction contracture (sometimes plus flexion and out-rotation contracture). 2. There are two groups of development of idiopathic scoliosis. The first group - small children, early rotation deformity, both scoliosis (L and Th), progression. The second group is connected only with the habit of permanent standing "at ease" on the right leg. Older children. L scoliosis, sometimes Th scoliosis. 3. X-ray pictures of spine with pelvis are necessary for proper diagnosis.4. Abduction contracture of the right hip is connected with "syndrome of contractures" of new-borns and babies.5. We see necessity to introduce new stretching-flexion asymmetric exercises and a special sports program for the children endangered with scoliosis. 6. We proved that the "new prophylactics" through "new clinical test" and "new rehabilitation treatment" at school children (5-6-7-8 years old) gives positives results.

Adolescent↗

PubMed1994

Exercise for arthritis.

The data available indicate that ROM, strengthening and aerobic conditioning exercises are safe for patients with OA, RA or AS, despite earlier concerns that exercise might exacerbate joint symptoms or accelerate disease. Less clear are the therapeutic benefits of exercise. In patients with OA, stretching, strengthening, and aerobic conditioning programmes can improve the deficits observed in these patients. The improvements observed generally have been small, and the evidence that these individual improvements result in improved overall function is minimal. None the less, it is likely that exercise will reduce pain, improve endurance for physical activities and improve cardiovascular fitness. Study of the long-term effects of exercise in the geriatric population, for sustaining independent living and functioning, is critically important for future health care and social expenditures. In RA, strengthening and aerobic conditioning exercise programmes can increase muscle strength and cardiovascular fitness and probably improve physical function as well. Improvements demonstrated in patients with RA seem more convincing than those in patients with OA and AS; this probably represents their poorer physical status prior to exercising. For patients with AS, intensive physiotherapy brings statistically significant short-term improvements in spinal and hip ROM which are only modestly clinically significant. It is possible that spinal mobility exercises decelerate loss of mobility over the long term, but controlled studies are needed to confirm this. Improvement in respiratory function with exercise appears to be related to cardiopulmonary fitness and perhaps to improvements in diaphragmatic respiration rather than to changes in thoracic cage mobility. Given the overall safety and likely benefits of the described forms of exercise, exercise should be included in the overall treatment of patients with OA, RA or AS. Careful patient evaluation and education about exercise should be a part of the exercise programme.

Arthritis↗

PubMed1997

Influence of load and stretch shortening cycle on the kinematics, kinetics and muscle activation that occurs during explosive upper-body movements.

Although explosive power in lower-body movements has been extensively studied, there is a paucity of research examining such movements in the upper body. This study aimed to investigate the influence of load and the stretch shortening cycle (SSC) on the kinematics, kinetics, and muscle activation that occurs during maximal effort throws. A total of 17 male subjects performed SSC and concentric only (CO) bench throws using loads of 15%, 30%, 45%, 60%, 75%, 90% and 100% of their previously determined one repetition maximum bench press. The displacement, velocity, acceleration, force and power output as well as the electromyogram (EMG) from pectoralis major, anterior deltoid, and triceps brachii were recorded for each throw. The results were compared using multivariate analysis of variance with repeated measures. A criterion alpha level of P < or = 0.05 was used. Similar force velocity power relationships were determined for this multijoint upper-body movement as has been found for isolated muscles, single joint movements, and vertical jumping. The highest power output was produced at the 30% [563 (104) W] and 45% [560 (86) W] loads during the SSC throws. Force output increased as a function of load; however, even the lighter loads resulted in considerable force due to the high accelerations produced. Average velocity, average and peak force, and average and peak power output were significantly higher for the SSC throws compared to the CO throws. However, peak velocity and height thrown were not potentiated by performing the pre-stretch because the duration and range of movement allowed the ability of the muscle to generate force at high shortening velocities to dominate the resulting throw. As such, explosive movements involving longer concentric actions than experienced during brief SSC movements may be limited by the ability of the muscle to produce force during fast contraction velocities.

Adult↗

PubMed1993

Clinical evaluation of the BackMate lower lumbar rehabilitation system: results of a preliminary study.

Back pain profoundly affects daily activities and quality-of-life parameters. It was the intent of the present study to evaluate a procedure of stretching and strengthening the lower back musculature with the aid of a pelvic stabilization device, the BackMate, for the treatment of lower back pain. Subjects suffering from chronic back pain (> 3 months in duration) were studied. The treatment program consisted of three therapy sessions per week for 3 weeks. Sitting time, walking distance, and lower back pain, parameters reported by the subjects, significantly improved regardless of age and sex of the subjects. Similarly, objective parameters, including forward bend, straight leg raise, and hamstring flexibility, significantly improved. This preliminary experience suggests that stretching and strengthening procedures performed with the aid of a pelvic stabilization device may prove to be a significant addition to current clinical treatment procedures for lower back pain.

Activities of Daily Living↗

PubMed2006

[Mechanotransduction and cellular response--a challenge toward development of mechano-pharmacology].

Mechanoreception and subsequent cellular/molecular mechanisms of signal transduction pathways in response to mechanical stresses, including hemodynamic factors, passive stretching, and exercise, are ubiquitous in living organisms. Of these, the cardiovascular system involving the heart and blood vessels is known to be particularly sensitive to mechanical stimuli, for example, stretching and intraluminal pressurization, which might mimic an acute and/or chronic change in blood pressure and flow, induce a variety of responses including contraction, activation of various kinases and ionic channels, production of vasoactive substances, gene expression, and phenotype changes. We have started to clarify the mechanisms underlying this basic principle in the cardiovascular system as it is now generally considered that obesity and a lack of exercise are serious risk factors for cardiovascular diseases such as hypertension, atherosclerosis, and type 2 diabetes. We further extended our research field of mechanotransduction into adipocytes, skeletal muscle cells, and pancreatic beta cells, all of which are related to the core concerns in cardiovascular disease, including the so-called metabolic syndrome. In the present article, we discuss briefly the prologue to our study of mechanotransduction and several topics in the recent progress in this interesting area. We also emphasize that it is important to recognize biomechanical factors and control them not only for improvement in our knowledge of health and disease but also for the development of new drugs.

Adipocytes↗

PubMed2003

Adding weights to stretching exercise increases passive range of motion for healthy elderly.

Stretching exercise is effective for increasing joint range of motion (ROM). However, the Surgeon General's Report and the American College of Sports Medicine cite a lack of studies identifying strategies capable of increasing the effectiveness of stretching exercise. This investigation evaluated adding modest weight (0.45-1.35 kg) to a stretching exercise routine (Body Recall [BR]) on joint ROM. Forty-three subjects ages 55-83 years participated in 1 of 2 training groups, BR, BR with weights (BR+W), or a control group (C). ROM was evaluated at the neck, shoulder, hip, knee, and ankle before and after 10 weeks of exercise. Using ANCOVA, significant differences (p < 0.01) were observed for right and left cervical rotation, hip extension, ankle dorsiflexion, ankle plantar flexion, and shoulder flexion. Post hoc analysis revealed that cervical rotation (left and right), hip extension, and ankle dorsiflexion for BR+W subjects differed significantly from BR and C (p < 0.01). Significant differences with shoulder flexion and ankle plantar flexion were found for both BR and BR+W in comparison to C (p < 0.01). Results indicate that addition of weights enhanced the effectiveness of stretching exercise for increasing joint ROM with 4 of the 6 selected measurements. Thus, a modest intensity exercise program that is within the reach of most elderly may significantly affect joint ROM and flexibility.

Activities of Daily Living↗

PubMed2005

Managing nocturnal leg cramps--calf-stretching exercises and cessation of quinine treatment: a factorial randomised controlled trial.

BACKGROUND: Quinine is a common treatment for nocturnal leg cramps but has potential side effects. An uncontrolled study suggested that calf-stretching exercises could prevent nocturnal leg cramps (night cramps) but these findings have never been confirmed. AIM: To assess the effect of calf-stretching exercises and cessation of quinine treatment for patients with night cramps taking quinine. DESIGN OF STUDY: Randomised controlled trial. SETTING: Twenty-eight general practices in southern England. METHOD: One hundred and ninety-one patients prescribed quinine for night cramps were randomised to one of four groups defined by two "advice" factors: undertake exercises and stop quinine. After 6 weeks they were advised that they could take quinine and undertake the exercises freely. Documentation of cramp at 12 weeks was achieved in 181 (95%) patients. Main outcome measures were: symptom burden score, and frequency of night cramps and quinine usage. RESULTS: At 12 weeks there was no significant difference in number of cramps in the previous 4 weeks (exercise = 1.95, 95% confidence interval [CI] = -3.01 to 6.90; quinine cessation = 3.45, 95% CI = -1.52 to 8.41) nor symptom burden or severity of cramps. However, after 12 weeks 26.5% (95% CI = 13.3% to 39.7%) more patients who had been advised to stop quinine treatment reported taking no quinine tablets in the previous week (odds ratio [OR] = 3.32, 95% CI = 1.37 to 8.06), whereas advice to do stretching exercises had no effect (OR = 0.73, 95% CI = 0.27 to 1.98). CONCLUSIONS: Calf-stretching exercises are not effective in reducing the frequency or severity of night cramps. Advising those on long-term repeat prescriptions to try stopping quinine temporarily will result in no major problems for patients, and allow a significant number to stop medication.

Aged↗

PubMed2006

Efficacy of interdisciplinary treatment for chronic nonmalignant pain patients in Japan.

OBJECTIVES: The implementation of interdisciplinary pain management is a relatively new concept in Japan. Although there are more than 4200 pain specialists in Japan at present, no multidisciplinary pain center has yet to be established. This prospective study is, to our knowledge, the first published evaluation of the effectiveness of multidisciplinary/interdisciplinary pain treatment in Japanese patients with chronic noncancer pain. METHODS: Ninety-nine patients with chronic noncancer pain were treated by an interdisciplinary approach in a Japanese outpatient pain clinic. Treatment was on the basis of the biopsychosocial model of pain and consisted of the following components: (1) education; (2) exercise and stretch; (3) long-term and short-term goal setting; (4) medication management; and (5) cognitive and behavioral techniques for problem solving and changing maladaptive behaviors. Each treatment session was 30 minutes and was held once every 1 to 3 weeks for 8 to 12 times according to the patients' progress and availability. The patients were assessed before and 2 to 4 weeks after the treatment. RESULTS: Results showed (1) 68.9% of patients reported a significant decrease in pain, (2) 92.0% stopped using inappropriate medication including nonsteroidal anti-inflammation drugs, benzodiazepines and muscle relaxants, (3) 51.4% underwent their usual daily activities without being disturbed by pain, and (4) 75.0% who had been unemployed because of pain returned to work. Overall, the treatment succeeded in 56.8% of the patients. CONCLUSIONS: Our results suggest that an interdisciplinary treatment based upon the biopsychosocial model of pain was associated with significant improvement in multiple outcomes in this sample of Japanese patients with chronic pain.

Chronic Disease↗