ConheceDOR: the development of a board game for modern pain education for patients with musculoskeletal pain

Valentim, Juliana Carvalho de Paiva; Meziat-Filho, Ney Armando; Nogueira, Leandro Calazans; Reis, Felipe J. Jandre

doi:10.5935/2595-0118.20190030

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REVIEW ARTICLE • BrJP 2 (2) • Apr-Jun 2019 • https://doi.org/10.5935/2595-0118.20190030 linkcopy

ConheceDOR: the development of a board game for modern pain education for patients with musculoskeletal pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic pain is one of the main challenges for health systems. Pain education and self-motivated strategies have great potential in the treatment of people with chronic pain, especially by modifying beliefs and behavior. The development of board games for educational purposes can contribute to the learning of pain concepts and behavioral strategies. The objective of this study was to develop a board game (ConheceDor) to be used as an intervention tool for pain education.

CONTENTS: The systematic review for the development of the game ConheceDor, considered the following search strategy: "chronic pain", "musculoskeletal pain", "health education", "patient education", "neuroscience education", "pain education", "therapeutic neuroscience education". The primary outcomes considered were pain intensity and disability. Fifteen studies were included, with a total of 1,486 participants. Six studies reported reduction on pain of at least 10%, and two studies reported an improvement of at least 30% on disability. For the development of the game, we elaborated the layout of the board, the rules and other components (dice, cards, and pins). The cards of the game included the contents commonly used in the randomized controlled trials: negative thoughts, pain neurophysiology, stress management, and relaxation, coping and exercises.

CONCLUSION: The development of the present board game was based on the critical appraisal of the content of educational strategies present in the literature. The board game can be a potent resource to be applied in clinical practice in people with musculoskeletal pain.

Keywords:
Chronic pain; Experimental games; Health education; Neuroscience-based education

Authors	Clinical condition	Population	Intervention group	Control group	Follow-up	Outcomes
Andersen et al.²⁸	Pain in the spine or upper back	n=141 F=78; Age=45.2±0.5 years	Personalized physical activity group = 1.5h of general health guidelines + aerobic and strength exercises for 50min (n=47). Group of self-management=1.5h of general health guidelines + weekly workshop of 2.5h for 6 weeks in groups of 12 to 18 people (n=47).	Reference treatment group = 1.5h of general health guidelines (n=47).	3 months	Intensity of pain with VAS (zero to 100mm); Ability to work (VAS zero to 100mm); TSK.
Bennell et al.²⁹	Chronic knee pain	n=148 F=83; Age=61.1±7.5 years	Three internet interventions: educational material on the exercises + educational material on coping + 7 consultations via Skype with a physiotherapist for exercise prescription (n=74).	Two interventions via the internet: educational material on the exercises + educational material on coping (n=74).	3 and 9 months	Mean pain during gait in the previous week (zero to 10); WOMAC and PSC.
Brage et al.²⁴	Chronic neck pain	n=20 F=20; Age=41.4±12.2 years	4 sessions of 1.5h on education + 8 sessions of 30min with specific exercises (shoulder girdle and shoulder, balance and aerobic training) (n=10).	4 sessions of 1.5h, covering topics on mechanisms, acceptance, coping strategies and definition of pain goals based on the concepts of pain management and cognitive-behavioral therapy (n=10).	4 and 12 months	Pain (NRS from zero to 10); Neck-related disability (NDI); Perceived Global Effect (GPE).
Carmody et al.²³	Chronic musculoskeletal pain (low back and neck pain, with and without radiculopathy, arthritis)	n=101 F=3; Age=67.5±9.5 years	Cognitive behavioral therapy by telephone (12 weeks) (n=50)	Telephone education (12 weeks) (n=51)	2, 5, 8 and 12 months	Health-related quality of life (SF-12v2); BDI; PBCL; CSQR; Intensity of pain (pain journal for two weeks); PSC.
Chiauzzi et al.¹⁵	Chronic low back pain	n=199 F=134; Age=46.1±11.9 years	Online education for low back pain (painACTION-Back Pain) (painACTION-Back Pain) n=104)	Low back pain guide that should be read in 4 weeks (n=105)	1, 3 and 6 months	BPI, ODQ, DASS, PGIC, CPCI, PSC, PSEQ FABQ.
Gallagher, McAuley and Moseley²²	Chronic musculoskeletal pain	n=79 F=48; Age=43.5±11 years	Booklet on pain education through metaphors (n=40).	Information booklet on pain (n=39).	3 months	PBQ, PSC, NRS 0-10, PSFS.
Lefort et al. ²⁰	Chronic musculoskeletal pain	n=110 F=82 Age=39.5 years	Psychoeducation program (2 hours per week for 6 weeks) (n=57)	Waiting list (n=53)	6 weeks	SF-36, PRI, SF-MPQ, SF-BDI; SOPA-D, VAS=100mm.
Meeus et al.²⁶	Chronic fatigue syndrome	n=48 F=40 Age=40.3±10.4 years	Neuroscience-based pain education (n=24)	Information on self-management seeking the balance between activity and rest to avoid exacerbations and establish realistic goals to increase activity (n=24).	Post-treatment	NPT, PCS, TSK, PCI.
Moseley, Nicholas and Hodges¹⁸	Chronic low back pain	n=58 F=33 Age=43.58 years	Neuroscience-based pain education (n=31)	Education on the anatomy of the spine (n=27)	Post-treatment	RMDQ, SOPA-R, PSC.
Nicholas et al.¹⁹	Chronic pain	n=141 F=96 Age=73.9±6.5 years	Self-management of pain (8 sessions of 2h for 4 weeks) + encouragement to practice exercises at home (n=49) Self-management of pain (8 sessions of 2h for 4 weeks) (n=53)	Waiting list (n=39)	1, 6 and 12 months	NRS, mRMDQ; DASS-21, TSK, PSEQ, PRSS.
Ris et al.²⁵	Chronic neck pain	n=200 F=149 Age=45.1 years	Pain education with a focus on the understanding/acceptance of pain and goals setting (4 sessions (1.5h each, once a month) + 8 sessions of exercises (neck muscles, balance, oculomotor training, shoulder girdle (n = 101)	Pain Education with a focus in the understanding/acceptance of pain and goals setting (4 sessions (1.5h each, once a month) (n=99)	4 months	SF-36, NDI, BDI-II, TSK.
Rizzo et al. ¹⁶	Chronic low back pain	n=100 F=80 Age=50±13.5 years	Neuroscience-based pain education (4 sessions; 2 times/week) + hypnosis (2h of self-hypnosis in 2 weeks + book with hypnosis suggestions) (n=50)	Neuroscience-based pain education (4 sessions; 2 times/week) (n=49)	3 months	NRS, RMDQ, PSC, GPE, PSFS.
Ryan et al.¹⁷	Chronic low back pain	n=38 F=25 Age=45.3±10.7 years	Neuroscience-based pain education + 6 sessions of exercises for 8 weeks (10min warm-up, 20-30min aerobic phase, and 10-15min slowdown) (n=20).	Neuroscience-based pain education (2.5 h reformulation of beliefs and attitudes regarding pain) (n=18)	3 months	NRS, TSK-13, PSEQ.
Thorn et al.²¹	Chronic musculoskeletal pain	n=73 F=65 Age=52.8±13.1 years	Cognitive-Behavioral Therapy + homework (1.5h, once/week, 10 weeks) (n=49)	Education on pain neurophysiology (1.5h, once/week, 10 weeks) (n=34)	6 months	BPI, RMDS, PSC, CES-D, QOLS.
Van Oosterwijck et al.²⁷	Fibromyalgia	n=30 F=26 Age=45.8±10.5 years	Neuroscience-based pain education (2 sessions; 30 minutes) (n=15)	Self-management (self-management techniques and handling of daily activities in relation to their symptoms). (2 sessions, 30 minutes) (n=15)	3 months	FIQ), SF-36, PCI, PCS, TSK, PVAQ.

Studies	Criteria											Total
Studies	1	2	3	4	5	6	7	8	9	10	11	Total
Andersen et al.²⁸	X	V	X	V	X	X	V	V	V	V	V	7
Bennell et al.²⁹	V	V	V	V	X	X	X	V	V	V	V	7
Brage et. al²⁴	V	V	V	V	X	X	V	X	V	V	V	7
Carmody et. al.²³	V	V	X	V	X	X	V	X	V	V	V	6
Chiauzzi et al.¹⁵	V	V	X	V	X	X	X	V	V	V	V	6
Gallagher, McAuley and Moseley²²	X	V	V	V	X	X	X	V	X	V	V	6
Lefort et al.²⁰	V	V	V	V	X	X	V	V	V	V	V	8
Meeus et al.²⁶	V	V	V	V	X	X	V	V	X	V	V	7
Moseley, Nicholas and Hodges¹⁸	V	V	X	V	X	X	V	V	X	V	V	7
Nicholas et al.¹⁹	V	V	X	V	X	X	V	X	V	V	V	6
Ris et al.²⁵	X	V	V	V	X	X	X	X	V	V	V	6
Rizzo et al.¹⁶	V	V	V	V	X	X	V	V	V	V	V	8
Ryan et al.¹⁷	X	V	V	V	X	X	V	V	X	V	V	7
Thorn et al.²¹	V	V	V	V	X	X	X	X	V	V	V	6
Van Oosterwijck et al.²⁷	V	V	X	V	V	X	V	V	V	V	V	8

Authors	Change from baseline (%)
	Short (≤3 months)		Medium (3-6 months)		Long (>6 months)
	Pain	Disability	Pain	Disability	Pain	Disability
Andersen et al.²⁸	- 6.3	-	-	-	-	-
Bennell et al.²⁹	-17.4	15.0	-	-	-24.1	20.9
Brage et. al²⁴	-	-	-	-	2.0	12.2
Carmody et. al.²³	-11.6	-	-13.9	-	-16.2	-
Chiauzzi et al.¹⁵	-7.8	6.7	-9.5	5.1	-14.8	2.5
Lefort et al.²⁰	-16.1	8.7	-	-	-	-
Moseley, Nicholas, Hodges¹⁸	-	6.6	-	-	-	-
Nicholas et al.¹⁹	-12.3	23.8	-12.5	20.4	-9.5	16.2
Ris et al.²⁵	-	2.2	-	-	-	-
Rizzo et al.¹⁶	-29.1	43.2	-	-	-	-
Ryan et al.¹⁷	-51.3	60.1	-	-	-	-
Thorn et al.²¹	-	-	-20.6	-16.6	-	-

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[TFN1] VAS = visual analog scale; PSC = Pain Catastrophizing Scale; WOMAC = Arthritis Self-Efficacy Scale; TSK = Tampa Scale of Kinesiophobia; NDI = Neck Disability Index; GPE = Global Perceived Effect; SF-12v2 = Short Form 12v2 Health Survey; BDI - Beck Depression Inventory; PBCL = Pain Behavior Checklist; CSQR = Coping Strategies Questionnaire Revised; BPI = Brief Pain Inventory; ODQ = Oswestry Disability Questionnaire; DASS = Depression Anxiety Stress Scale; PGIC = Patient Global Impression of Change; CPCI = Chronic Pain Coping Inventory; PSEQ = Pain Self-Efficacy Questionnaire); FABQ = Fear-Avoidance Beliefs Questionnaire; PBQ = Pain Biology Questionnaire; NRS = Numerical Rating Scale; PSFS = Patient-Specific Functional Scale; SF-36 = Medical Outcomes Study Short Form-36; PRI = Pain Rating Index; SF-MPQ = Short Form-McGill Pain Questionnaire; SF-BDI = Short Version - Beck Depression Inventory; SOPA-D = Survey of Pain Attitudes); NPT = Neurophysiology of Pain Test; PCI = Pain Coping Inventory; RMDQ = Roland Morris Disability Questionnaire; SOPA-R = Survey of Pain Attitudes-Revised; mRMDQ = Roland Morris Disability Questionnaire-Modified; DASS-21 = Depression Anxiety Stress Scales; PRSS = Pain Response Self-Statements Scale; BDI-II = Beck Depression Inventory-II; RMDS = Roland-Morris Disability Scale; CES-D = Center for Epidemiological Studies Depression Scale; QOLS = Quality of Life Scale -QOLS; FIQ = Fibromyalgia Impact Questionnaire; SF-36 = Medical Outcomes Short Form 36 Health Status Survey; PVAQ = Pain Vigilance and Awareness Questionnaire.