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Osaji J, Ojimba C, Ahmed S. The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature. J Clin Med Res 2020; 12:629-633. [PMID: 33029268 PMCID: PMC7524566 DOI: 10.14740/jocmr4311] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Acceptance and commitment therapy (ACT) is a form of behavioral therapy that teaches people to learn to accept rather than avoid challenging situations in their lives. ACT has shown to be an intervention with great success in the reduction of various mental disorders and substance use disorders (SUDs). The core of ACT when used in SUD treatment is guiding people to accept the urges and symptoms associated with substance misuse (acceptance) and use psychological flexibility and value-based interventions to reduce those urges and the symptoms (commitment). The purpose of this study is to review the existing literature to examine the evidence on the use of ACT in the management of SUD. Methods A thorough search of four databases (CINAHL, PubMed.gov, PsycINFO and PsycNET) from 2011 to 2020 was conducted using search terms like ACT, ACT and SUD, ACT, and substance misuse. The articles retrieved were critically appraised using the Critically Appraised Topic (CAT) Checklist. Results Most of the studies showed that ACT was effective in the management of SUD showing significant evidence of a reduction in substance use or total discontinuation with subsequent abstinence. Conclusions The literature review concluded that success has been achieved using ACT either as monotherapy or in combination with other therapy in the treatment of individuals with SUD.
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Affiliation(s)
- Joy Osaji
- Texas Tech University Health Science Center, Lubbock, TX, USA
| | | | - Saeed Ahmed
- Rutland Regional Medical Center, Rutland, VT, USA
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Exploratory Study of Common Changes in Client Behaviors Following Routine Psychotherapy: Does Psychological Flexibility Typically Change and Predict Outcomes? JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09468-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AbstractPsychological flexibility refers to a modifiable pattern of interacting with one’s experiences with openness and awareness (acceptance-and-mindfulness) and active engagement guided by personal values (commitment-and-behavioral activation). Psychological flexibility has a base of research literature that supports its utility as a model of human behavioral health and pathology. Although the model is central in organizing the therapeutic processes of Acceptance and Commitment Therapy, researchers have argued that psychological flexibility processes might be activated in other effective therapy models included in routine psychotherapy, even if those models do not purport to target those processes. This study explored the degree to which aspects of clients’ psychological flexibility, specifically acceptance-and-mindfulness and commitment-and-behavioral activation, changed after episodes of routine psychotherapy and were predictors of outcome changes for a clinically heterogeneous sample (n = 197) in a naturalistic treatment setting. Results showed statistically significant and small improvements in acceptance-and-mindfulness (d = 0.22) and commitment-and-behavioral activation (d = 0.24) and that changes in psychological flexibility were significant predictors of changes in both flourishing and distress, explaining 42% and 23% of those respective therapy outcomes. Whereas a mix of therapy approaches may slightly improve psychological flexibility, more explicit attention to strengthening it might benefit the work of diverse psychotherapists given its potential relevance to achieving common overarching therapy outcomes.
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Anthony CA, Rojas EO, Keffala V, Glass NA, Shah AS, Miller BJ, Hogue M, Willey MC, Karam M, Marsh JL. Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17750. [PMID: 32723723 PMCID: PMC7458063 DOI: 10.2196/17750] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. OBJECTIVE This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. METHODS Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. RESULTS A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone-based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04). CONCLUSIONS In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. TRIAL REGISTRATION ClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546.
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Affiliation(s)
- Chris A Anthony
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Edward Octavio Rojas
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Valerie Keffala
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Natalie Ann Glass
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Apurva S Shah
- Children's Hospital of Philadelphia Main Campus Division of Orthopaedics, Philadelphia, PA, United States
| | - Benjamin J Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Matthew Hogue
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Michael C Willey
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Matthew Karam
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - John Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Abstract
Opioid use disorder and opioid misuse continue to increase rapidly in prevalence in North America. Nurses play a critical role in managing pain in patients who are at risk for opioid use disorder. The interplay of pain and opioid use disorder provides nurses with an opportunity to address urgent needs while treating patients across the continuum of care. This article reviews strategies for assessing risk for opioid use disorder while treating patients with pain. Implementing these approaches into daily nursing practice may improve patient care and help reduce the incidence of opioid use disorder.
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Affiliation(s)
- Barbara St Marie
- Barbara St. Marie is Assistant Professor, College of Nursing, University of Iowa, 50 Newton Road, Iowa City, IA
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A contextual-behavioral perspective on chronic pain during the COVID-19 pandemic and future times of mandated physical distancing. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Grazzi L, Rizzoli P. Acceptance and Commitment Therapy (ACT) vs Erenumab for High Frequency Episodic Migraine Without Aura: Time to Take the Gloves Off! Headache 2020; 60:804-806. [DOI: 10.1111/head.13776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/18/2020] [Accepted: 01/29/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Licia Grazzi
- Headache and Neuroalgology Unit Neurological Institute “C. Besta” IRCCS Foundation Milan Italy
| | - Paul Rizzoli
- John Graham Headache Center Brigham & Women Faulkner Hospital Boston MA USA
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Clarke HA, Manoo V, Pearsall EA, Goel A, Feinberg A, Weinrib A, Chiu JC, Shah B, Ladak SSJ, Ward S, Srikandarajah S, Brar SS, McLeod RS. Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery. Can J Pain 2020; 4:67-85. [PMID: 33987487 PMCID: PMC7951150 DOI: 10.1080/24740527.2020.1724775] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Abstract
This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence.
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Affiliation(s)
- Hance A. Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada
| | - Varuna Manoo
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Emily A. Pearsall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Akash Goel
- Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Adina Feinberg
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aliza Weinrib
- Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jenny C. Chiu
- Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada
| | - Bansi Shah
- Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Salima S. J. Ladak
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Ward
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Sanjho Srikandarajah
- Department of Anaesthesia, North York General Hospital, Toronto, Ontario, Canada
| | - Savtaj S. Brar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Robin S. McLeod
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Horn A, Kaneshiro K, Tsui BCH. Preemptive and Preventive Pain Psychoeducation and Its Potential Application as a Multimodal Perioperative Pain Control Option. Anesth Analg 2020; 130:559-573. [DOI: 10.1213/ane.0000000000004319] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Garland EL, Brintz CE, Hanley AW, Roseen EJ, Atchley RM, Gaylord SA, Faurot KR, Yaffe J, Fiander M, Keefe FJ. Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:91-105. [PMID: 31682676 PMCID: PMC6830441 DOI: 10.1001/jamainternmed.2019.4917] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/29/2019] [Indexed: 12/15/2022]
Abstract
Importance Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. Objective To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. Data Sources For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. Study Selection Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. Data Extraction and Synthesis Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. Main Outcomes and Measures The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. Results Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. Conclusions and Relevance The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.
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Affiliation(s)
- Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
- College of Social Work, University of Utah, Salt Lake City
| | - Carrie E. Brintz
- Program on Integrative Medicine, Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill
| | - Adam W. Hanley
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
- College of Social Work, University of Utah, Salt Lake City
| | - Eric J. Roseen
- Department of Family Medicine, Boston University and Boston University School of Medicine, Boston, Massachusetts
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts
| | - Rachel M. Atchley
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts
| | - Susan A. Gaylord
- Program on Integrative Medicine, Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill
| | - Keturah R. Faurot
- Program on Integrative Medicine, Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill
| | - Joanne Yaffe
- College of Social Work, University of Utah, Salt Lake City
| | | | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
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St Marie B, Broglio K. Managing Pain in the Setting of Opioid Use Disorder. Pain Manag Nurs 2019; 21:26-34. [PMID: 31648905 DOI: 10.1016/j.pmn.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/27/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
SPECIFIC CLINICAL ISSUE Healthcare providers are challenged with managing pain and minimizing morbidity and mortality associated with opioid use disorder. MAJOR PRACTICE RECOMMENDATIONS BASED ON BEST EVIDENCE The purpose of this article is to guide acute and ambulatory care clinicians in managing pain in patients with opioid use disorder. Included in this article is a review of medications used for opioid use disorder, a discussion of the management of patients with active opioid use disorder and acute or chronic pain, and a discussion of the management of acute and chronic pain in people in recovery both on and off medications for opioid use disorder.
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Affiliation(s)
| | - Kathleen Broglio
- Section of Palliative Medicine, Geisel School of Medicine at Dartmouth, Collaboratory for Implementation Sciences at Dartmouth, Lebanon, New Hampshire
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Hadlandsmyth K, Dindo LN, Wajid R, Sugg SL, Zimmerman MB, Rakel BA. A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain. Psychooncology 2019; 28:2210-2217. [PMID: 31430830 DOI: 10.1002/pon.5209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Oncologic breast surgeries carry a risk for persistent postsurgical pain. This study was a randomized pilot and feasibility study of a single-session Acceptance and Commitment Therapy (ACT) intervention compared with treatment as usual among women undergoing surgery for breast cancer or ductal carcinoma in situ. METHODS Participants were recruited via letter of invitation and follow-up phone call from a single site in the United States from 2015 to 2017. Participants were at risk for persistent postsurgical pain, based on young age (<50), a preexisting chronic pain condition, or elevated anxiety, depression, or pain catastrophizing. RESULTS The 54 participants were female with a mean age of 52.91 years (SD=11.80). At 3-month postsurgery, 11% of the sample reported moderate-severe pain (>3 on a 0-10 numeric rating scale) in the operative breast or with arm movement. Written qualitative responses indicated that the majority of participants who received the intervention understood the concepts presented and reported continued practice of exercises learned in the session. The between group effect sizes for moderate-severe pain and elevated anxiety at 3-month post-surgery were small (Phi=0.08 and 0.16, respectively). The between group effect sizes for depression, pain acceptance, and pain catastrophizing at 3-month postsurgery were minimal. CONCLUSIONS This study found small positive effects on postsurgical pain and anxiety for a single-session ACT intervention among women with breast cancer. This study supports the use of ACT with this population.
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Affiliation(s)
- Katherine Hadlandsmyth
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Lilian N Dindo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Center for Innovations, Quality, and Effectiveness, Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas
| | - Roohina Wajid
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Sonia L Sugg
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Kanzler KE, Pugh JA, McGeary DD, Hale WJ, Mathias CW, Kilpela LS, Karns-Wright TE, Robinson PJ, Dixon SA, Bryan CJ, Moring JC, McCracken LM. Mitigating the Effect of Pain Severity on Activity and Disability in Patients with Chronic Pain: The Crucial Context of Acceptance. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1509-1518. [PMID: 30590737 PMCID: PMC6686120 DOI: 10.1093/pm/pny197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effect of pain severity on activity levels and physical disability in the context of high pain acceptance. We hypothesized that pain acceptance moderates the effect of pain severity on general activity and physical disability, such that at higher levels of acceptance, the deleterious effect of pain is mitigated. METHODS Two hundred seven patients with chronic pain were recruited from three clinics in a large southwestern military treatment facility. Participants completed an anonymous self-report battery of standardized measures, including the Chronic Pain Acceptance Questionnaire, modified Oswestry Disability Index, and Pain Severity and General Activity subscales of the West Haven-Yale Multidimensional Pain Inventory. RESULTS Chronic pain acceptance was found to significantly moderate relations between pain severity and general activity (b = 0.0061, t(198) = 2.75, P = 0.007, 95% confidence interval [CI] = 0.002 to 0.011) and pain severity and disability (b = 0.036, t(193) = -2.564, P = 0.011, 95% CI = -0.063 to -0.008). In the context of higher acceptance, the negative effect of pain on activity and disability appeared reduced. Conversely, in the context of low acceptance, the effect of pain on disability appeared accentuated at all levels of pain severity. CONCLUSIONS Higher acceptance mitigated both activity level and disability in a military-affiliated clinical sample of patients with chronic pain. Results further establish the role of acceptance in relation to functioning in a unique sample of people with chronic pain. These findings have implications for understanding and enhancing functioning in chronic pain populations.
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Affiliation(s)
- Kathryn E Kanzler
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Jacqueline A Pugh
- South Texas Veterans Health Care System
- Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Donald D McGeary
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Charles W Mathias
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Lisa S Kilpela
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Tara E Karns-Wright
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | | | - Sara A Dixon
- 81 DS/SGD Orofacial Pain, Keesler Air Force Base
| | - Craig J Bryan
- National Center for Veterans Studies and Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | | | - Lance M McCracken
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Abstract
Chronic pain is extremely prevalent in older adults and is associated with significant morbidity, including limited mobility, social isolation, and depressed mood. Pain is defined by a biopsychosocial model highlighting the importance of a multidisciplinary approach to treatment, including multimodal medications, selected interventions, physical therapy and rehabilitation, and psychological treatments. In this narrative review, the authors highlight the use of these approaches in older adults with specific attention paid to considerations unique to aging, including alterations in drug metabolism, avoidance of polypharmacy, and physiologic changes predisposing to painful conditions.
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Hadlandsmyth K, Dindo LN, St Marie BJ, Wajid R, Embree JL, Noiseux NO, Tripp-Reimer T, Zimmerman MB, Rakel BA. Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments: Reliability and Validity in Veterans Following Orthopedic Surgery. Eval Health Prof 2019; 43:207-212. [PMID: 31195828 DOI: 10.1177/0163278719856406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The patient-reported outcomes measurement information system (PROMIS) offers standardized assessment measures of clinically relevant patient-reported outcomes. This study evaluated the reliability and validity of select PROMIS measures with U.S. military veterans following orthopedic surgery. Data for the current study were collected as part of a pilot randomized control trial assessing the efficacy of a 1-day Acceptance and Commitment Therapy workshop on persistent postsurgical pain in at-risk veterans undergoing orthopedic surgery. Sixty-seven participants completed surveys 3 months after surgery. Participants completed the following PROMIS instruments: PROMIS Anxiety Short Form 8a, PROMIS Depression Short Form 8b, and PROMIS Pain Interference Short Form 8a. PROMIS measures were compared to the Generalized Anxiety Disorder 7-Item Scale, the Patient Health Questionnaire 9-Item Scale, and the Brief Pain Inventory Pain Interference subscale, respectively. All three PROMIS measures demonstrated excellent internal consistency (Cronbach's αs ranged from .93 to .96) and each loaded onto a single factor. The PROMIS measures were moderately correlated with their respective comparison measures (r = .69 to .76). The PROMIS anxiety and PROMIS depression measures were highly correlated to one another (r = .91). Findings highlight the potential utility of these PROMIS measures in veterans following orthopedic surgery and the overlap between the PROMIS depression and anxiety measures in this sample.
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Affiliation(s)
- Katherine Hadlandsmyth
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | | | - Roohina Wajid
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | | | - Nicolas O Noiseux
- Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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