Biopsychosocial education for individuals with subacute and chronic pain in the hand, wrist, or elbow : a pilot study

Despite best practices in the treatment of elbow, wrist, and hand injuries, some individuals continue to have pain beyond the expected time of recovery. Lingering pain can contribute to psychological, social, and economic burdens. The biopsychosocial pain neuroscience education (PNE) has been successful in treating individuals with lingering pain in musculoskeletal injuries, but literature involving the use of PNE for individuals with distal upper extremity pain is lacking. The purpose of this study is to investigate whether a PNE program will reduce pain and improve outcomes in individuals following elbow, wrist, and hand injuries using a rehabilitation counseling lens. A total of ten individuals aged 18 years and older (M= 46.6, SD =13.83) from the United States with subacute or chronic pain in the distal upper extremities completed the four weekly telehealth sessions lasting between 30 to 60 minutes each. This PNE program was a preexperimental design where all individuals received the intervention.A one-way repeated measures multivariate analysis of variance (MANOVA) was first used to determine the effects of the pain neuroscience educational program on all biopsychosocial variables as a whole. Six dependent variables were studied: perceived pain using the Pain Numeric Rating Scale (NRS), pain catastrophizing using the Pain Catastrophizing Scale (PCS), kinesiophobia using the Tampa Scale for Kinesiophobia -11 (TSK-11), and function and social participation using the Quick Disabilities of the Arm, Shoulder, and Hand Outcome Measure (QuickDASH) and the Canadian Occupational Performance Measure (COPM). Participants improved from pretest to posttest in all variables in the primary analysis except for QuickDASH. The difference between the participants from pretest to posttest on the combined variables using the one-way repeated measures MANOVA could not be utilized as the data did not meet the required assumptions. Using a univariate analysis, three of the six variables were found statistically and clinically significant with large effect sizes. These variables include pain (F (1, 9) = 13.048, p = .006; \uD835\uDC5B\uD835\uDC5D2 = .592); kinesiophobia (F (1, 9) = 14.188, p = .004; \uD835\uDC5B\uD835\uDC5D2 = .612) as well as satisfaction with occupational performance (F (1, 9) = 14.656, p = .004; \uD835\uDC5B\uD835\uDC5D2= .620). Pain catastrophizing (F (1, 9) = 1.858, p = .206 \uD835\uDC5B\uD835\uDC5D2 = 0.171) and occupational performance (F (1, 9) =4.279, p= .069, \uD835\uDC5B\uD835\uDC5D2= 0.322) achieved large effect sizes but were underpowered to achieve statistical significance at the 95% confidence interval. Function and social participation measured by the QuickDASH was neither statistically significant nor clinically significant (F (1, 9) =.005, p = .943, \uD835\uDC5B\uD835\uDC5D2= 0.001).Exploratory analyses indicated positive outcomes. Participants achieved a statistically significant improvement in mood from pretest to posttest with a large effect size F(1,9) =5.335, p =.046; \uD835\uDC5B\uD835\uDC5D2 = .372. A strong working alliance between the researcher and participants was achieved (goals, M= 18.5, 95% CI [17.14, 19.86], tasks, M= 17.2, 95% CI [15.45, 18.95], and bond, M= 18.7, 95% CI [17.69, 19.71]). Participants reported that the brief PNE program was at least moderately to extremely effective at reducing their pain, and they were at least moderately to extremely satisfied with the intervention. Participants also reported reduced usage of medication to treat pain from pretest to posttest.This pilot study provided effect sizes for assessment tools to better study pain using PNE in the distal upper extremity population. These effect sizes can provide a better prediction for appropriate power in future randomized controlled trials.