Background & Aims

An epidemiologic survey of approximately 11,000 Japanese people aged 18 years and
over revealed that the prevalence of chronic pain (pain score of >5 on a Visual Analogue
Scale lasting at least 6 months) was 15.4% [1]. Similarly, in a large-scale survey, 17 million
reported chronic pain in 2004, with that number increasing to 23.15 million in 2010 [2]. Recent clinical practice guidelines for chronic pain indicate, with a high evidence level, that the combination of exercise and cognitive behavioral therapy (CBT) is effective [3]. The purpose of this study was to analyze the effectiveness of CBT-based exercise facilitation method using the “Ikiiki Rehabilitation Notebook” [4] in patients with intractable chronic pain. “Ikiiki” means active in Japanese.

Methods

The subjects were 12 males and 23 females (mean age 54) with chronic low back (n=17), lower extremity (n=14), high back (n=2) , LBP with lower extremity (n=1) or neck (n=1) pain without specific lesions. Indications for using the notebook were as follows: (1) Numerical Rating Scale (NRS) for pain > 3/10, (2) all patients had pain somewhere in the body, other than headaches, for more than 3 months, resulting in disability in activities of daily living (ADL), and (3) the patients are eager to do rehabilitation therapy. Patients were asked to write in their notebooks daily or once a week regarding their feeling, though, and exercise routine (muscle exertion, gait distance). Once every 2 weeks, the patients returned to the clinic to go over the notebook. Each case was evaluated in terms of the NRS, the pain disability assessment scale (PDAS), pain catastrophizing scale (PCS), and EuroQol 5 Dimension (EQ-5D) which evaluate quality of life (QOL) at pretreatment and post-treatment.

Results

The combination of CBT and therapeutic exercise was found to be more effective for improving pain and physical function than general physiotherapy [5]. In this study, the NRS, PDAS, PCS, and EQ-5D were improved significantly 11 months after starting to use the “Ikiiki Rehabilitation Notebook”.

Conclusions

Only a few studies have reported the effects of combining CBT and exercise therapy in
Japan, but Hirase et al. conducted a study targeting community-dwelling elderly people [6].
The patients of the present study had more severe conditions in terms of pain intensity, PCS,
and PDAS than those in Hirase’s report before treatment. However, the NRS, PCS, and PDAS scores, improved to the same level in both studies after treatment. Although it is difficult to
make a direct comparison because of the differences in the subject age, duration of treatment,
and exercise menu, it is noteworthy that use of the Ikiiki Rehabilitation Notebook
method resulted in similar improvements as reported by Hirase et al. In conclusion, the Ikiiki Rehabilitation Notebook would be a valuable tool to educate patients about the cause and treatment of pain and to actively facilitate CBT-based exercise, resulting in the improvement of ADL and QOL.

References

[1] Nakamura, M.; Nishiwaki, Y.; Ushida, T.; Toyama, Y. Prevalence and characteristics of chronic musculoskeletal pain in Japan. J. Orthop. Sci. 2011, 6, 424–432.
[2] Yabuki, S.; Ushida, T.; Takeshita, K.; Saura, R.; Ogawa, S.; Katsumata, A.; Hatanaka, S. A nationwide survey of chronic pain sufferers in Japan. Clin. Orthop. Surg. 2012, 47, 127–134.
[3] The Committee for Clinical Practice Guideline for Chronic Pain. Rehabilitation. In Clinical Practice Guideline for Chronic Pain; Shinko Trading Co. Ltd.: Chuo, Japan, 2018; pp. 306–326.
[4] Shinji Kimura, Masako Hosoi, Naofumi Otsuru, et al. A novel exercise facilitation method in combination with cognitive behavioral therapy using the Ikiiki Rehabilitation Notebook for intractable chronic pain: Technical report and 22 cases. Healthcare2021,9(9) 1209;  https://doi.org/10.3390/healthcare9091209
[5] Rihn, J.A.; Radcliff, K.; Norvell, D.C.; Eastlack, R.; Phillips, F.M.; Berland, D.; Sherry, N.; Freedman, M.; Vaccaro, A.R. Comparative effectiveness of treatments for chronic low back pain: A multiple treatment comparison analysis. Clin. Spine Surg. 2017, 30, 204–225.
[6] Hirase, T.; Kataoka, H.; Nakano, J.; Inokuchi, S.; Sakamoto, J.; Okita, M. Effects of a psychosocial intervention programme
combined with exercise in community-dwelling older adults with chronic pain: A randomized controlled trial. Eur. J. Pain 2018,
22, 592–600.

Presenting Author

Shinji Kimura

Poster Authors

Shinji Kimura

MD, PhD

Niigata University Medical and Dental Hospital

Lead Author

Masako Hosoi

MD

Kyushu?University?Hospital

Lead Author

Topics

  • Models: Musculoskeletal