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Shaygan M, Böger A, Kröner-Herwig B. How does reduction in pain lead to reduction in disability in patients with musculoskeletal pain? J Pain Res 2019; 12:1879-1890. [PMID: 31354338 PMCID: PMC6580133 DOI: 10.2147/jpr.s197533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/28/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose Reduction in pain following multidisciplinary treatment is most often associated with a reduction in disability. To further elaborate the relationship between pain intensity and disability, the present study investigated three main questions: first, whether multidisciplinary treatment leads to a significant improvement in pain, disability and psychological variables (depression, pain acceptance and catastrophizing). Second, it was examined whether pain reduction may account for significant changes in the psychological variables (pre- to follow-up change scores). Finally, it was analyzed whether the psychological changes mediate the association between reduction in pain and in disability after controlling for age, sex and pain history. Patients and methods Patients suffering from chronic musculoskeletal pain (n=279) attended a German inpatient multidisciplinary program lasting 15 consecutive days on average, with self-report data collected at pretreatment, posttreatment and three-month follow-up. Results Repeated measures ANOVAs showed a significant improvement in pain intensity, disability, pain acceptance, catastrophizing and depression at posttreatment and follow-up. Univariate regression analyses revealed that changes in pain intensity accounted for significant changes in depression, pain catastrophizing and pain acceptance (pre- to follow-up change scores). The results of Multiple Mediation Procedure showed that pain reduction did affect reduction in disability through improvement of depression, catastrophizing and acceptance. Conclusion Our findings support a cognitive-behavioral model of pain that posits an important role for pain-related cognitive and emotional processes in long-term outcomes following multidisciplinary pain treatment, in particular for the modulation of disability due to pain. The results add evidence to the notion that pain-related cognitions are dynamic features varying over time dependent on the internal situation. Perspective The current findings are relevant to the management of patients with musculoskeletal pain. The results support the notion that, in contrast with the view of enduring personality traits, pain-related cognitions and emotions reflect a situational response that varies over time.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Centre, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Andreas Böger
- Pain Management Clinic at the Red Cross Hospital, Kassel, Germany
| | - Birgit Kröner-Herwig
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, Georg-August-University, Göttingen, Germany
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Dorscht L, Schön C, Geiss C, Gräßel E, Donath C. Access to Pain Management Programs: A Multifactorial Analysis of the Pathways of Care for Chronic Pain Patients in the University Clinic Erlangen. DAS GESUNDHEITSWESEN 2019; 82:e94-e107. [PMID: 31185498 DOI: 10.1055/a-0832-2173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Different treatment options are offered for patients suffering from chronic pain, which differ in intensity and costs: 1) monodisciplinary treatment, mostly in outpatient care and 2) interdisciplinary treatment with the option of participating in pain management programs as outpatients or inpatients. The present work investigates how patients at the University Clinic Erlangen receiving monodisciplinary treatment differ from those receiving interdisciplinary treatment (research question I) as well as how patients participating in a pain management program differ from those who do not (research question II). The aim is to generate insights into whether the differences between the patient groups under various treatment modalities reflect the officially defined criteria for the indication of chronic pain management programs. METHODS Routine data of 1,833 patients treated from January 2008 to March 2013 at the University Clinic Erlangen were analyzed. After univariate preanalyses and checks for multicollinearity, the remaining variables were used for the final multivariate model (multiple binary logistic regression) for research question I and II. RESULTS Research question I: Patients getting interdisciplinary treatment were more often employed, had higher affective experience of pain, more often regarded their pain as treatable, had more often participated in at least one pain-associated rehabilitation treatment in the past, were younger and rarely had application for retirement in consideration. Research question II: Patients who participated in a pain management program were more often female, more often employed, described their pain as mainly located at the upper part of the body, had more concomitant symptoms, were more often diagnosed with musculoskeletal pain and rarely had a retirement request pending. CONCLUSIONS It could be shown that patients in the analyzed pathways of care mainly differed in demographic variables, and regarding pain management programs, also in the type of pain. Differences between patients in different treatment paths reflecting the officially defined indication criteria for chronic pain management programs were detectable only to a minor extent. Clearer and operational practical guidance should help support the clinical decision to assign patients to different treatment options and close the gap between theory and practice.
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Affiliation(s)
- Lisa Dorscht
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische Universitätsklinik Erlangen, Erlangen
| | - Christoph Schön
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Erlangen, Erlangen
| | - Christa Geiss
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Erlangen, Erlangen
| | - Elmar Gräßel
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische Universitätsklinik Erlangen, Erlangen
| | - Carolin Donath
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische Universitätsklinik Erlangen, Erlangen
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Whether chronic pain is medically explained or not does not moderate the response to cognitive-behavioural therapy. J Psychosom Res 2019; 121:29-36. [PMID: 30928209 DOI: 10.1016/j.jpsychores.2019.03.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether pain-related treatment outcomes, following an online Cognitive Behavioural Therapy (CBT) intervention for chronic pain, were moderated by the pain etiology of a medically explained or unexplained origin. METHODS Data were available from 471 participants who completed the online pain management program between March 2013 and August 2014. Participants' pain symptoms were classified as being medically explained symptoms (MES: n = 292) or medically unexplained symptoms (MUS: n = 222) via analysis of clinical data. Outcome variables were pain-related disability, average pain intensity, depression and anxiety. RESULTS Moderation analyses were non-significant for all dependent variables. Between group differences (CBT and control) were larger for depression in those classified with MES, compared with MUS (MUS: mean change = -3.50 [95% CI = -4.98 to -2.22]; MES: mean change = -5.72 [95% CI = -7.49 to -4.09]). However, between group differences were small for pain intensity (MUS: mean change = -0.03 [95% CI = -0.83 to 0.81]; MES: mean difference = -1.12 [95% CI = -1.84 to 0.40]). CONCLUSION The therapeutic outcomes examined in this study associated with an online CBT program do not appear to be altered by whether the participants' pain symptoms are medically explained or unexplained.
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Gerdle B, Åkerblom S, Stålnacke BM, Brodda Jansen G, Enthoven P, Ernberg M, Dong HJ, Äng BO, Boersma K. The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation – a SQRP study of more than 20,000 chronic pain patients. Scand J Pain 2019; 19:693-711. [DOI: 10.1515/sjpain-2019-0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up.
Methods
Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods.
Results
The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements.
Conclusions
Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP.
Implications
This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences , Linköping University , SE-581 85 Linköping , Sweden , Phone: +46763927191
| | - Sophia Åkerblom
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
- Department of Psychology , Lund University , Lund , Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine , Umeå University , Umeå , Sweden
| | - Gunilla Brodda Jansen
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine , Stockholm , Sweden
| | - Paul Enthoven
- Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Malin Ernberg
- Department of Dental Medicine , Karolinska Institutet , Stockholm , Sweden
- Scandinavian Center for Orofacial Neuroscience (SCON) , Huddinge , Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Björn O Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , 23100 Huddinge , Sweden
- Center for Clinical Research Dalarna – Uppsala University , Falun , Sweden
- School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work , Örebro University , Örebro , Sweden
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Edmond SN, Turk DC, Williams DA, Kerns RD. Considerations of trial design and conduct in behavioral interventions for the management of chronic pain in adults. Pain Rep 2019; 4:e655. [PMID: 31583335 PMCID: PMC6749925 DOI: 10.1097/pr9.0000000000000655] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION A growing number and type of nonpharmacological approaches for the management of chronic pain have demonstrated at least modest evidence of efficacy, and for some, there is emerging evidence of their effectiveness in relatively large scale trials. Behavioral approaches are those that generally seek to promote adaptive behavioral change in the service of reducing pain and improving physical and emotional functioning and quality of life. Despite a substantial empirical literature supporting the clinical utility of these approaches, a large number of unanswered questions remain and clinical trials to answer some of these questions are needed. Although considerations for development and enactment of data-analytic plans are generally similar to those in pharmacological trials (eg, intent-to-treat, prespecifying outcomes and time points, and handling of missing data), there may be some important differences to consider when planning and conducting clinical trials examining these behavioral approaches. OBJECTIVES The primary objective of this article is to describe some aspects of clinical trials for behavioral approaches for the management of chronic pain that requires special consideration. METHODS Important topics discussed include: (1) intervention development, (2) research design considerations (adequate and appropriate control and comparison conditions), (3) appropriate outcomes, (4) recruitment and sampling biases and blinding, (5) intervention fidelity and adherence, and (6) demographic and cultural considerations. RESULTS AND CONCLUSIONS A number of methodological recommendations are made in the service of encouraging the conduct of high-quality research comparable with that performed for pharmacological and other medical interventions.
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Affiliation(s)
- Sara N. Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - David A. Williams
- Departments of Anesthesiology
- Internal Medicine
- Psychiatry, and
- Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Robert D. Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Departments of Neurology and
- Psychology, Yale University, New Haven, CT, USA
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Suso-Ribera C, Camacho-Guerrero L, Osma J, Suso-Vergara S, Gallardo-Pujol D. A Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients. Front Psychol 2019; 10:907. [PMID: 31133917 PMCID: PMC6524714 DOI: 10.3389/fpsyg.2019.00907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/04/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation). METHODS The study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female. RESULTS Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = -0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (β = 0.87, t = 4.96, p < 0.001, R 2 change = 0.177). This association was found to be moderated by frustration tolerance (β = -0.49, t = -2.80, p = 0.006, R 2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41). CONCLUSION The results suggest that frustration tolerance may render adaptive by facilitating the positive effect that a reduction in pain intensity has on physical health status. The study findings are discussed in the context of personalized therapy with an emphasis on how to maximize the effectiveness of current interventions for pain.
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Affiliation(s)
- Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | | | - Jorge Osma
- Department of Psychology and Sociology, Instituto de Investigación Sanitaria de Aragón, Universidad de Zaragoza, Teruel, Spain
| | | | - David Gallardo-Pujol
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
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Gerdle B, Åkerblom S, Brodda Jansen G, Enthoven P, Ernberg M, Dong HJ, Stålnacke BM, Äng BO, Boersma K. Who benefits from multimodal rehabilitation - an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation. J Pain Res 2019; 12:891-908. [PMID: 30881099 PMCID: PMC6411315 DOI: 10.2147/jpr.s190003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual's life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments. METHODS Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods. RESULTS Based on >35,000 patients, 35%-40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%-24% vs 6%-8% in the category without psychological distress) and low education level (20.7%-20.8% vs 26%-27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R 2=0.40-0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901-16,119; subgroup 2: n=20,690-20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes. CONCLUSION The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
| | - Sophia Åkerblom
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Gunilla Brodda Jansen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Paul Enthoven
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Björn O Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Center for Clinical Research Dalarna - Uppsala University, Falun, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Okifuji A, Neikrug A. Update and future perspective of behavioral medicine in the treatment for chronic pain. Pain Manag 2019; 9:161-173. [PMID: 30785366 DOI: 10.2217/pmt-2017-0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chronic pain is a biopsychosocial condition, and behavioral medicine has made significant contributions to the understanding of the phenomenon and optimization of therapeutic outcomes. The objective of this article is to provide future perspectives of behavioral medicine in pain management based upon recent development in the field. We will briefly review the mainstream approach of cognitive-behavioral therapy, its variations and new and innovative approaches that are on the horizon. We also review strategies that address potential barriers to pain management. Behavioral medicine is a promising field in pain medicine. The future growth is likely to come from addressing how we incorporate the patient heterogeneity into our treatment approaches and a better understanding of its role in a multimodal treatment.
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Affiliation(s)
- Akiko Okifuji
- Department of Anesthesiology, Division of Pain Medicine, University of Utah, Salt Lake City, UT, USA 84108
| | - Ariel Neikrug
- Department of Psychiatry, University of California Irvine, CA 92868, USA 92868
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Aggarwal VR, Fu Y, Main CJ, Wu J. The effectiveness of self‐management interventions in adults with chronic orofacial pain: A systematic review, meta‐analysis and meta‐regression. Eur J Pain 2019; 23:849-865. [DOI: 10.1002/ejp.1358] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/20/2018] [Accepted: 12/30/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Vishal R. Aggarwal
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
| | - Yu Fu
- Faculty of Medicine & Health, School of Healthcare University of Leeds Leeds UK
| | - Chris J. Main
- Research Institute for Primary Care & Health Keele University Keele UK
| | - Jianhua Wu
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
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113
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Carriere JS, Martel MO, Meints SM, Cornelius MC, Edwards RR. What do you expect? Catastrophizing mediates associations between expectancies and pain-facilitatory processes. Eur J Pain 2019; 23:800-811. [PMID: 30506913 DOI: 10.1002/ejp.1348] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pain expectancies are associated with altered pain sensitivity in individuals with chronic pain. However, little is known about the processes by which pain expectancies impact pain processing. This study assessed the association between pain expectancies and temporal summation (TS) of pain, and examined whether pain catastrophizing mediated this association. METHODS In this cross-sectional study, participants (437 chronic low back pain [CLBP] patients, 115 controls) completed self-report measures of pain intensity, pain expectancies and pain catastrophizing before undergoing psychophysical pain-testing procedures designed to assess mechanical TS of mechanical pain. Pearson's correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of pain catastrophizing on the association between pain expectancies and TS of pain. RESULTS Temporal summation of pain was significantly associated with pain expectancies (r = 0.113) and pain catastrophizing (r = 0.171) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain expectancies and TS of pain in CLBP patients (ab = 0.309, 95% CI = 0.1222-0.5604), but not in healthy controls (ab = -0.125, 95% CI = -0.5864 to 0.0244). CONCLUSIONS The findings from this study suggest that compared to controls, CLBP patients show increased sensitivity to mechanical pain procedures and enhanced pain-facilitatory processing, proving further evidence for changes in central nervous system pain processing in CLBP patients. Our results also suggest that pain catastrophizing may be the mechanism by which pain expectancies are associated with TS of pain in CLBP patients. SIGNIFICANCE Individuals with chronic low back pain who expect higher levels of pain and catastrophize about their pain are more likely to experience altered pain sensitivity. Our results point to catastrophizing as a mechanism of action through which psychological factors may operate and lead to the development and maintenance of chronic low back pain.
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Affiliation(s)
- Junie S Carriere
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Marc Olivier Martel
- Faculties of Dentistry and Medicine, McGill University, Montreal, Quebec, Canada
| | - Samantha M Meints
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Marise C Cornelius
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
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Taylor SS, Oddone EZ, Coffman CJ, Jeffreys AS, Bosworth HB, Allen KD. Cognitive Mediators of Change in Physical Functioning in Response to a Multifaceted Intervention for Managing Osteoarthritis. Int J Behav Med 2019; 25:162-170. [PMID: 29453622 DOI: 10.1007/s12529-017-9689-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Although non-pharmacological interventions have been shown to improve physical functioning in individuals with osteoarthritis (OA), the mechanisms by which this occurs are often unclear. This study assessed whether changes in arthritis self-efficacy, perceived pain control, and pain catastrophizing mediated changes in physical functioning following an osteoarthritis intervention involving weight management, physical activity, and cognitive-behavioral pain management. METHOD Three hundred Veteran patients of 30 primary care providers with knee and/or hip OA were cluster randomized to an OA intervention group or usual care. The OA intervention included a 12-month phone-based patient behavioral protocol (weight management, physical activity, and cognitive-behavioral pain management) plus patient-specific OA treatment recommendations delivered to primary care providers. RESULTS Using linear mixed models adjusted for provider clustering, we observed that baseline to 6-month changes in arthritis self-efficacy and pain control partially mediated baseline to 12-month physical functioning improvements for the intervention group; catastrophizing did not. CONCLUSION Findings of a mediating role of arthritis self-efficacy and pain control in intervention-related functional changes are consistent with hypotheses and align with theoretical assertions of the role of cognitions in cognitive and behavioral interventions for chronic pain. However, contrary to hypotheses, catastrophizing was not found to be a mediator of these changes.
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Affiliation(s)
- Shannon Stark Taylor
- Durham VA HealthCare System (152), HSR&D, 508 Fulton St., Durham, NC, 27705, USA.
| | - Eugene Z Oddone
- Durham VA HealthCare System (152), HSR&D, 508 Fulton St., Durham, NC, 27705, USA.,Duke University Medical Center, Durham, NC, USA
| | - Cynthia J Coffman
- Durham VA HealthCare System (152), HSR&D, 508 Fulton St., Durham, NC, 27705, USA.,Duke University Medical Center, Durham, NC, USA
| | - Amy S Jeffreys
- Durham VA HealthCare System (152), HSR&D, 508 Fulton St., Durham, NC, 27705, USA
| | - Hayden B Bosworth
- Durham VA HealthCare System (152), HSR&D, 508 Fulton St., Durham, NC, 27705, USA.,Duke University Medical Center, Durham, NC, USA
| | - Kelli D Allen
- Durham VA HealthCare System (152), HSR&D, 508 Fulton St., Durham, NC, 27705, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:168-182. [PMID: 29408484 PMCID: PMC6067990 DOI: 10.1016/j.pnpbp.2018.01.017] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.
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Affiliation(s)
- S M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA.
| | - R R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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Gennis H, Pillai Riddell R, O'Neill MC, Katz J, Taddio A, Garfield H, Greenberg S. Parental Psychological Distress Moderates the Impact of a Video Intervention to Help Parents Manage Young Child Vaccination Pain. J Pediatr Psychol 2018; 43:1170-1178. [PMID: 30137497 DOI: 10.1093/jpepsy/jsy058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/08/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The current study sets out to conduct a post hoc analysis of the moderating effect of parent psychological distress on a pediatric pain management intervention. Methods Parents of 6-month-old infants (n = 64) and 18-month-old toddlers (n = 64 each) were randomized to a treatment (The ABCDs of Pain Management) or control video and videotaped during the vaccination. Parent psychological distress was also measured at the vaccination. Outcomes were children's pain, parent worry, and parent soothing behavior post-vaccination. Results Parent psychological distress only moderated video effect on toddler pain during the regulation phase. Parent psychological distress did not moderate the impact of the video on parent worry or parent soothing post-needle at either age. The video did increase parent soothing in parents of both infants and toddlers, and reduced worry in parents of toddlers. Conclusions To our knowledge, this is the first study to assess a moderating factor on a child pain management intervention. The video's efficacy was moderated for toddlers' pain regulation, such that parents with high psychological distress did not show as much benefit from the intervention. No other moderations were found in either age group for any other outcome. Main effects for the video impacting soothing behavior of parents of both infants and toddlers were confirmed, and a new finding of video efficacy was seen through the significantly lower worry of toddlers' parents post-needle. Given the nonclinical sample, low levels of psychological distress were found. Efforts to replicate this study in a higher risk sample are necessary.
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Affiliation(s)
| | | | | | - Joel Katz
- York University.,The Hospital for Sick Children, Toronto, Canada.,University of Toronto
| | - Anna Taddio
- York University.,The Hospital for Sick Children, Toronto, Canada.,University of Toronto
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Miller VE, Poole C, Golightly Y, Barrett D, Chen DG, Ohrbach R, Greenspan JD, Fillingim RB, Slade GD. Characteristics Associated With High-Impact Pain in People With Temporomandibular Disorder: A Cross-Sectional Study. THE JOURNAL OF PAIN 2018; 20:288-300. [PMID: 30292793 DOI: 10.1016/j.jpain.2018.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
High-impact (disabling) pain diminishes the quality of life and increases health care costs. The purpose of this study was to identify the variables that distinguish between high- and low-impact pain among individuals with painful temporomandibular disorder (TMD). Community-dwelling adults (N = 846) with chronic TMD completed standardized questionnaires that assessed the following: 1) sociodemographic characteristics, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high-impact pain, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate the contribution of variables from each domain. Cross-validated area under the receiver operating characteristic curve (AUC) quantified model discrimination. One-third of the participants had high-impact pain. Sociodemographic variables discriminated weakly between low- and high-impact pain (AUC = .61, 95% confidence interval [CI] = 0.57, 0.65), with the exception of race. An 18-variable model encompassing all 4 domains had good discrimination (AUC = 0.79, 95% CI = 0.75, 0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites) (AUC = 0.79, 95% CI = 0.76, 0.82). Duration of pain, sex, and experimental pain testing results were not associated. The characteristics that discriminated most effectively between people with low- and high-impact TMD pain included clinical pain features and the ability to cope with pain. PERSPECTIVE: This article presents the results of a multivariable model designed to discriminate between people with high- and low-impact pain in a community-based sample of people with painful chronic TMD. The findings emphasize the importance of catastrophizing, jaw limitation, and painful body sites associated with pain-related impact.
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Affiliation(s)
- Vanessa E Miller
- Program on Integrative Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deborah Barrett
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ding-Geng Chen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, Maryland
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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118
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Feliu-Soler A, Montesinos F, Gutiérrez-Martínez O, Scott W, McCracken LM, Luciano JV. Current status of acceptance and commitment therapy for chronic pain: a narrative review. J Pain Res 2018; 11:2145-2159. [PMID: 30323649 PMCID: PMC6174685 DOI: 10.2147/jpr.s144631] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is well known that chronic pain is prevalent, complex to manage, and associated with high costs, in health care and society in general. Thanks to advances in new forms of cognitive behavioral therapy (known as third-wave CBT), currently clinicians and researchers have an empirically validated psychological treatment with increasing research support for the treatment of chronic pain. This treatment is called acceptance and commitment therapy (ACT). The main aim of this paper is to provide a narrative review that summarizes and integrates the current state of knowledge of ACT in the management of chronic pain as well as discuss current challenges and opportunities for progress. Based on the psychological flexibility model, ACT extends previous forms of CBT and integrates many CBT-related variables into six core therapeutic processes. ACT is a process-based therapy that fosters openness, awareness, and engagement through a wide range of methods, including exposure-based and experiential methods, metaphors, and values clarification. To our knowledge, there are three published systematic reviews and meta-analyses that support the effectiveness of ACT for chronic pain and many studies focused on specific processes derived from the psychological flexibility model. There is also promising support for the cost-effectiveness of ACT; however, the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery. Additional well-designed economic evaluations are needed. Other research aims include delineating the neurobiological underpinnings of ACT, refining available outcome and process measures or develop new ones for ACT trials, and meeting the challenge of wide dissemination and implementation in real-world clinical practice.
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Affiliation(s)
- Albert Feliu-Soler
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain,
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain,
| | - Francisco Montesinos
- Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
- Instituto ACT, Madrid, Spain
| | | | - Whitney Scott
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lance M McCracken
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- INPUT Pain Management, Guys and St Thomas NHSFT, London, UK
| | - Juan V Luciano
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain,
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain,
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Martinez-Calderon J, Struyf F, Meeus M, Luque-Suarez A. The association between pain beliefs and pain intensity and/or disability in people with shoulder pain: A systematic review. Musculoskelet Sci Pract 2018; 37:29-57. [PMID: 29980139 DOI: 10.1016/j.msksp.2018.06.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pain beliefs might play a role in the development, transition, and perpetuation of shoulder pain. OBJECTIVE To systematically review and critically appraise the association and the predictive value of pain beliefs on pain intensity and/or disability in shoulder pain. METHODS An electronic search of PubMed, EBSCOhost, AMED, CINAHL, EMBASE, and PubPsych, and grey literature was searched from inception to July 2017. Study selection was based on observational studies exploring the association and the predictive value of pain beliefs on pain intensity and/or disability in shoulder pain. RESULTS A total of thirty-three articles were included with a total sample of 10,293 participants with shoulder pain. In the cross-sectional analysis, higher levels of pain catastrophizing and kinesiophobia were significantly associated with more pain intensity and disability, whereas higher levels of expectations of recovery and self-efficacy were significantly associated with lower levels of pain intensity and disability. In the longitudinal analysis, higher levels of pain catastrophizing, fear-avoidance and kinesiophobia at baseline predicted greater pain intensity and disability overtime. Higher levels of self-efficacy and expectations of recovery at baseline predicted a reduction in levels of pain intensity and disability overtime. CONCLUSIONS Evidence suggests that pain beliefs are associated with and predict the course of pain intensity and disability in shoulder pain. However, the overall body of the evidence after applying the GRADE approach was very low across studies. Further research using higher quality longitudinal designs and procedures would be needed to establish firm conclusions.
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Affiliation(s)
- Javier Martinez-Calderon
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium; Department of Rehabilitation Sciences and Physiotherapy Department, Ghent University, Ghent, Belgium; Pain in Motion International Research Group, Belgium(1)
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Cheng ST, Leung CMC, Chan KL, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. The relationship of self-efficacy to catastrophizing and depressive symptoms in community-dwelling older adults with chronic pain: A moderated mediation model. PLoS One 2018; 13:e0203964. [PMID: 30226892 PMCID: PMC6143242 DOI: 10.1371/journal.pone.0203964] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/30/2018] [Indexed: 11/18/2022] Open
Abstract
Self-efficacy has been consistently found to be a protective factor against psychological distress and disorders in the literature. However, little research is done on the moderating effect of self-efficacy on depressive symptoms in the context of chronic pain. This cross-sectional study aimed to examine if pain self-efficacy attenuated the direct relationship between pain intensity and depressive symptoms, as well as their indirect relationship through reducing the extent of catastrophizing when feeling pain (moderated mediation). 664 community-dwelling Chinese older adults aged 60-95 years who reported chronic pain for at least three months were recruited from social centers. They completed a battery of questionnaires on chronic pain, pain self-efficacy, catastrophizing, and depressive symptoms in individual face-to-face interviews. Controlling for age, gender, education, self-rated health, number of chronic diseases, pain disability, and pain self-efficacy, pain catastrophizing was found to partially mediate the connection between pain intensity and depressive symptoms. Furthermore, the relationship between pain intensity and depressive symptoms was moderated by pain self-efficacy. Self-efficacy was also found to moderate the relationship between pain intensity and catastrophizing and the moderated mediation effect was confirmed using bootstrap analysis. The results suggested that with increasing levels of self-efficacy, pain intensity's direct effect on depressive symptoms and its indirect effect on depressive symptoms via catastrophizing were both reduced in a dose-dependent manner. Our findings suggest that pain self-efficacy is a significant protective factor that contributes to psychological resilience in chronic pain patients by attenuating the relationship of pain intensity to both catastrophizing and depressive symptoms.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, United Kingdom
- * E-mail:
| | - Candi M. C. Leung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ka Long Chan
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoon Ping Chen
- Department of Anaesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Yu Fat Chow
- Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Joanne W. Y. Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Alexander C. B. Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Jenny S. W. Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Edward M. F. Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Cindy W. C. Tam
- Department of Psychiatry, North District Hospital, Hong Kong SAR, China
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Strömbom Y, Karlsson J, Fredrikson M, Melin L, Magnusson P. Cognitive behavioral therapy for frequent attenders in primary care. Health Sci Rep 2018; 1:e80. [PMID: 30623103 PMCID: PMC6266570 DOI: 10.1002/hsr2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 11/25/2022] Open
Abstract
AIM The aim of the study is to investigate if cognitive behavioral therapy given in a group setting affects anxiety and depression, stress, pain, coping strategies during daily life, and health-related quality of life (HRQoL), among frequent attenders (FAs) in primary care. METHODS Cognitive behavioral therapy was offered to 331 FAs between 18 and 65 years of age, of whom 89 accepted and 54 completed all steps in the protocol; patients were assigned to 1 of 3 groups: 0, 6, and 12-month waiting time. The therapy consisted of 12 sessions administered in group format. Outcome measures were Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Everyday Life Stress (ELS), Coping Strategy Questionnaire, Multidimensional Pain Inventory-Swedish version, and Short Form-36. RESULTS Mean age among patients who completed cognitive behavioral therapy was 49.9 years, with a female majority (79.6%). Anxiety and depression scores were reduced after treatment (BAI 16.7 vs 13.6; BDI 16.3 vs 15.7; HADS-Anxiety 8.41 vs 6.05; HADS-Depression 7.09 vs 5.69). Because waiting time itself did not affect symptoms, differences reflect treatment effects. Stress ratings were not affected by treatment. Use of nonadaptive coping strategies like praying and hoping and catastrophizing decreased. Frequent attenders experienced a higher sense of life control. Frequent attenders reported significantly lower HRQoL than general Swedish population norms in all 8 Short Form-36 domains including mental and physical component summary scores (MCS and PCS), and all domains were unaffected by treatment. CONCLUSION Cognitive behavioral therapy exerts some beneficial effects in FAs. Content of treatment addressed musculoskeletal pain, stress, anxiety, and depression. This broad approach resulted in reduced anxiety, depression, and impact of pain because of enhanced life control.
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Affiliation(s)
- Ylva Strömbom
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSweden
- Department of PsychologyUppsala UniversityUppsalaSweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Mats Fredrikson
- Department of PsychologyUppsala UniversityUppsalaSweden
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Lennart Melin
- Department of PsychologyUppsala UniversityUppsalaSweden
| | - Peter Magnusson
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSweden
- Cardiology Research Unit, Department of MedicineKarolinska InstitutetStockholmSweden
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Tanaka R, Hirohama K, Ozawa J. Can muscle weakness and disability influence the relationship between pain catastrophizing and pain worsening in patients with knee osteoarthritis? A cross-sectional study. Braz J Phys Ther 2018; 23:266-272. [PMID: 30193850 DOI: 10.1016/j.bjpt.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To verify if the relationship between pain catastrophizing and pain worsening would be mediated by muscle weakness and disability in patients with symptomatic knee osteoarthritis. METHODS This was a cross-sectional study in a hospital out-patient setting. Convenience sampling was used with a total of 50 participants with symptomatic knee osteoarthritis. Pain and the activities of daily livings (ADL) were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. Pain catastrophizing was assessed using the Coping Strategy Questionnaire (CSQ) subscale. Muscle strength of knee extension and 30-s chair stand test (30CST) were also assessed. Path analysis was performed to test the hypothetical model. Goodness of fit of models were assessed by using statistical parameters such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). RESULTS The chi-square values were not significant (chi-square=0.283, p=0.594), and the indices of goodness of fit were high, implying a valid model (GFI=1.000; AGFI=0.997; CFI=1.000; RMSEA=0.000). Pain was influenced significantly by muscle strength and ADL; muscle strength was influenced significantly by ADL via 30CST; ADL was influenced by pain catastrophizing. CONCLUSION The relationship between pain catastrophizing with pain worsening are mediated by muscle weakness and disability.
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Affiliation(s)
- Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan.
| | - Kenta Hirohama
- Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan
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Knoerl R, Barton DL, Holden JE, Krauss JC, LaVasseur B, Smith EML. Médiateurs potentiels d’amélioration de la neuropathie périphérique chimio-induite douloureuse par une intervention cognitivocomportementale en ligne. Can Oncol Nurs J 2018; 28:184-190. [PMID: 31148827 PMCID: PMC6516917 DOI: 10.5737/23688076283184190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objet Des données préliminaires ont révélé qu’une intervention autoguidée cognitivocomportementale de gestion de la douleur (PROSPECT) était efficace contre la neuropathie périphérique chronique douloureuse induite par chimiothérapie (NPCI), mais le mécanisme d’action demeure inconnu. L’objectif de cette analyse secondaire a consisté à déterminer si les changements par rapport à l’anxiété, à la dépression, aux troubles du sommeil ou à la fatigue diminuaient la douleur après l’utilisation de PROSPECT chez les patients atteints de NPCI. Méthodologie En tout, 60 participants ont été sélectionnés au hasard pour recevoir soit l’intervention autoguidée cognitivocomportementale contre la douleur (accès pendant huit semaines), soit le traitement habituel. Un journal sur sept jours de suivi de la douleur due à la NPCI et le système PROMIS (Patient Reported Outcomes Measurement Information System) de mesure de l’anxiété, de la dépression, de la fatigue et des troubles du sommeil ont été utilisés avant et après l’étude (huit semaines). L’analyse de la médiation causale a été utilisée pour quantifier les médiateurs d’amélioration quant aux douleurs les plus intenses. Résultats Aucun des médiateurs hypothétiques n’a eu un effet statistiquement important sur les douleurs les plus fortes (n = 38). Implications D’autres recherches sont nécessaires pour déterminer les médiateurs potentiels d’intensité de la douleur qui peuvent être ciblés par des stratégies cognitivocomportementales spécifiques afin d’améliorer la gravité de la douleur de la CIPN.
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Affiliation(s)
- Robert Knoerl
- Chercheur boursier postdoctoral, Phyllis Cantor, Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215, Courriel : , Téléphone : 617-632-6386
| | - Debra L Barton
- Mary Lou Willard, professeure, française de soins infirmiers; University of Michigan Medical School, Ann Arbor, M.I.; courriel :
| | - Janean E Holden
- Barbara A. Therrien, professeure en soins infirmiers, University of Michigan School of Nursing, Ann Arbor, M.I.; courriel :
| | - John C Krauss
- Professeure adjointe, University of Michigan, Comprehensive Cancer Center, Ann Arbor, M.I.; courriel :
| | - Beth LaVasseur
- Directrice de la recherche et des opérations, St. Joseph Mercy Hospital, Ann Arbor, M.I.; courriel :
| | - Ellen M L Smith
- Professeurs adjointe, University of Michigan School of Nursing, Ann Arbor, M.I.; courriel :
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Knoerl R, Barton DL, Holden JE, Krauss JC, LaVasseur B, Smith EML. Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention. Can Oncol Nurs J 2018; 28:178-183. [PMID: 31148833 PMCID: PMC6516921 DOI: 10.5737/23688076283178183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Preliminary evidence suggests that a self-guided cognitive and behaviourally-based pain management intervention (PROSPECT) is effective for chronic painful chemotherapy-induced peripheral neuropathy (CIPN), but its mechanism of action is unknown. The purpose of this secondary analysis was to explore if changes in anxiety, depression, sleep-related impairment, or fatigue mediated improvements in worst pain following PROSPECT in individuals with chronic painful CIPN. METHODS Sixty participants were randomized to receive self-guided cognitive behavioural pain management (access for eight weeks) or treatment as usual. A seven-day worst CIPN pain diary and the PROMIS measures of anxiety, depression, fatigue, and sleep-related impairment were administered pre/posttest (eight-weeks). Causal mediation analysis was used to quantify mediators of worst pain improvement. RESULTS None of the hypothesized mediators had a statistically significant effect on worst pain (n=38). IMPLICATIONS Further research is needed to identify potential mediators of pain intensity that can be targeted by specific cognitive behavioural strategies to improve painful CIPN severity.
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Affiliation(s)
- Robert Knoerl
- Post-Doctoral Research Fellow, Phyllis F. Cantor, Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215,
| | - Debra L Barton
- Mary Lou Willard French Professor of Nursing, University of Michigan School of Nursing, Ann Arbor, MI,
| | - Janean E Holden
- Barbara A. Therrien Collegiate Professor of Nursing, University of Michigan School of Nursing, Ann Arbor, MI,
| | - John C Krauss
- Assistant Professor, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI,
| | - Beth LaVasseur
- Director of Oncology Research and Operation, St. Joseph Mercy Hospital, Ann Arbor, MI,
| | - Ellen M L Smith
- Associate Professor, University of Michigan School of Nursing, Ann Arbor, MI,
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Åkerblom S, Perrin S, Rivano Fischer M, McCracken LM. The Relationship Between Posttraumatic Stress Disorder and Chronic Pain in People Seeking Treatment for Chronic Pain. Clin J Pain 2018; 34:487-496. [DOI: 10.1097/ajp.0000000000000561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The effectiveness of various computer-based interventions for patients with chronic pain or functional somatic syndromes: A systematic review and meta-analysis. PLoS One 2018; 13:e0196467. [PMID: 29768436 PMCID: PMC5955495 DOI: 10.1371/journal.pone.0196467] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/15/2018] [Indexed: 12/28/2022] Open
Abstract
Computer-based interventions target improvement of physical and emotional functioning in patients with chronic pain and functional somatic syndromes. However, it is unclear to what extent which interventions work and for whom. This systematic review and meta-analysis (registered at PROSPERO, 2016: CRD42016050839) assesses efficacy relative to passive and active control conditions, and explores patient and intervention factors. Controlled studies were identified from MEDLINE, EMBASE, PsychInfo, Web of Science, and Cochrane Library. Pooled standardized mean differences by comparison type, and somatic symptom, health-related quality of life, functional interference, catastrophizing, and depression outcomes were calculated at post-treatment and at 6 or more months follow-up. Risk of bias was assessed. Sub-group analyses were performed by patient and intervention characteristics when heterogeneous outcomes were observed. Maximally, 30 out of 46 eligible studies and 3,387 participants were included per meta-analysis. Mostly, internet-based cognitive behavioral therapies were identified. Significantly higher patient reported outcomes were found in comparisons with passive control groups (standardized mean differences ranged between -.41 and -.18), but not in comparisons with active control groups (SMD = -.26 - -.14). For some outcomes, significant heterogeneity related to patient and intervention characteristics. To conclude, there is a minority of good quality evidence for small positive average effects of computer-based (cognitive) behavior change interventions, similar to traditional modes. These effects may be sustainable. Indications were found as of which interventions work better or more consistently across outcomes for which patients. Future process analyses are recommended in the aim of better understanding individual chances of clinically relevant outcomes.
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Gandy M, Karin E, Jones MP, McDonald S, Sharpe L, Titov N, Dear BF. Exploring psychological mechanisms of clinical response to an internet-delivered psychological pain management program. Eur J Pain 2018; 22:1502-1516. [PMID: 29754439 DOI: 10.1002/ejp.1239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The evidence for Internet-delivered pain management programs for chronic pain is growing, but there is little empirical understanding of how they effect change. Understanding mechanisms of clinical response to these programs could inform their effective development and delivery. METHODS A large sample (n = 396) from a previous randomized controlled trial of a validated internet-delivered psychological pain management program, the Pain Course, was used to examine the influence of three potential psychological mechanisms (pain acceptance, pain self-efficacy, fear of movement/re-injury) on treatment-related change in disability, depression, anxiety and average pain. Analyses involved generalized estimating equation models for clinical outcomes that adjusted for co-occurring change in psychological variables. This was paired with cross-lagged analysis to assess for evidence of causality. Analyses involved two time points, pre-treatment and post-treatment. RESULTS Changes in pain-acceptance were strongly associated with changes in three (depression, anxiety and average pain) of the four clinical outcomes. Changes in self-efficacy were also strongly associated with two (anxiety and average pain) clinical outcomes. These findings suggest that participants were unlikely to improve in these clinical outcomes without also experiencing increases in their pain self-efficacy and pain acceptance. However, there was no clear evidence from cross-lagged analyses to currently support these psychological variables as direct mechanisms of clinical improvements. There was only statistical evidence to suggest higher levels of self-efficacy moderated improvements in depression. CONCLUSIONS The findings suggest that, while clinical improvements are closely associated with improvements in pain acceptance and self-efficacy, these psychological variables may not drive the treatment effects observed. SIGNIFICANCE This study employed robust statistical techniques to assess the psychological mechanisms of an established internet-delivered pain management program. While clinical improvements (e.g. depression, anxiety, pain) were closely associated with improvements in psychological variables (e.g. pain self-efficacy and pain acceptance), these variables do not appear to be treatment mechanisms.
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Affiliation(s)
- M Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M P Jones
- Department of Psychology, Macquarie University, Sydney, Australia
| | - S McDonald
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Sharpe
- Department of Psychology, University of Sydney, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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128
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Devan H, Hale L, Hempel D, Saipe B, Perry MA. What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis. Phys Ther 2018; 98:381-397. [PMID: 29669089 DOI: 10.1093/ptj/pzy029] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 02/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-management interventions fostering self-efficacy improve the well-being of people with chronic pain. PURPOSE The purpose of this study was to synthesize the enablers (what works) and barriers (what does not) of incorporating self-management strategies for people in everyday life after completion of a pain self-management intervention. DATA SOURCES Major electronic databases (MEDLINE, AMED, PsycINFO, Cochrane Library, PubMed, CINAHL, Scopus, and Google Scholar) were searched from inception to July 2016. STUDY SELECTION Study selection included qualitative and mixed-method studies that explored the perceptions of individuals with chronic pain after completion of a self-management intervention. DATA EXTRACTION A thematic analysis approach was used to synthesize the review findings, and a Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence. DATA SYNTHESIS Thirty-three studies with 512 participants were included. Enablers to self-management included self-discovery-the ability to distinguish self (ie, body, thoughts, and feelings) from pain; feeling empowered by incorporating self-management strategies into practice; and supportive ambience via collaborative relationships with clinicians and support from family and friends. Barriers to self-management included difficulty with sustaining motivation for pain self-management; distress experienced from ongoing pain, anxiety, and depression; and unsupportive relationships with clinicians, family, and friends. LIMITATIONS This review only included interventions that involved at least 4 self-management skills; thus, informative studies may have been missed. The follow-up period varied from immediately after the intervention to 72 months following the intervention; therefore, it is uncertain which of the key enablers and barriers were most influential long term. Only articles published in the English language were included; studies conducted in low- and middle-income countries could not be located. CONCLUSIONS The sustained effort to self-manage chronic pain could be exhausting, and motivation could wane over time following intervention. Providing intermittent support in the form of booster sessions and peer support groups may be important. Person-centered care via shared decision making and guided problem solving is essential to facilitating ongoing self-management.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB)
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
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129
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Arewasikporn A, Turner AP, Alschuler KN, Hughes AJ, Ehde DM. Cognitive and affective mechanisms of pain and fatigue in multiple sclerosis. Health Psychol 2018; 37:544-552. [PMID: 29672097 DOI: 10.1037/hea0000611] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the extent to which pain catastrophizing, fatigue catastrophizing, positive affect, and negative affect simultaneously mediated the associations between common symptoms of multiple sclerosis (MS; i.e., pain, fatigue) and impact on daily life, depressive symptoms, and resilience. METHOD Participants were community-dwelling adults with MS (N = 163) reporting chronic pain, fatigue, and/or moderate depressive symptoms. Multiple mediation path analysis was used to model potential mediators of pain and fatigue separately, using baseline data from a randomized controlled trial comparing two symptom self-management interventions. RESULTS In the pain model, pain catastrophizing was a mediator of pain intensity with pain interference and depression. Negative affect was a mediator of pain intensity with depression and resilience. In the fatigue model, fatigue catastrophizing was a mediator of fatigue intensity with fatigue impact and depression. Positive affect was a mediator of fatigue intensity with depression and resilience. CONCLUSIONS These findings provide preliminary support for the presence of differential effects of cognitive-affective mediators and suggest potential targets for psychological interventions based on an individual's clinical presentation. The differential mediating effects also support the inclusion of both positive and negative aspects of psychological health in models of pain and fatigue, which would not be otherwise apparent if negative constructs were examined in isolation. To our knowledge, this is the first study to utilize a multivariate path analysis approach to examine cognitive-affective mediators of pain and fatigue in MS, while also examining positive and negative constructs concurrently. (PsycINFO Database Record
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Affiliation(s)
- Anne Arewasikporn
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Aaron P Turner
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Abbey J Hughes
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine
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130
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Wahlund K, Larsson B. Long-term treatment outcome for adolescents with temporomandibular pain. Acta Odontol Scand 2018; 76:153-160. [PMID: 29073802 DOI: 10.1080/00016357.2017.1394490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aims to evaluate long-term, self-perceived outcome in adulthood for individuals treated as adolescents for temporomandibular disorder (TMD) pain in two previous randomized controlled trials (RCTs). MATERIALS AND METHODS The study included 116 subjects (81% females) treated for frequent TMD pain in two separate RCTs 5-21 (M = 14.8, SD =4.9) years previously. Treatment consisted of occlusal appliance (OA) (n = 41, 35.3%) or relaxation training (RT) combined with information for the control (Co) group (n = 50, 43.1%), both compared to non-responders receiving additional, sequential treatment (ST) in a crossover study (n = 25, 21.6%). Participants answered a questionnaire on their experience of frequency and intensity of TMD pain impaired chewing capacity and daily social activities, help-seeking behaviour and treatment, general health, other pain, and depressive symptoms. RESULTS Older participants reported lower levels of frequency and intensity of TMD pain, impairment, and depressive symptoms, as well as better general health. Females reported more frequent and more intense TMD pain, greater impairment and more often reported 'other pain' compared to males. Non-responders receiving ST experienced significantly more TMD, and other pain and higher impairment levels compared to other groups. Those treated with an OA had sought additional treatment significantly less often since the RCTs than ST and RT/Co-treated individuals. CONCLUSIONS Adolescents treated with OA showed somewhat better sustained improvement over the extended follow-up period than those treated with RT/Co. Non-responders to treatment and females exhibited a poorer outcome. These groups need particular attention and extended or different treatments to achieve a better long-term outcome.
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Affiliation(s)
- Kerstin Wahlund
- Department of Stomatognathic Physiology, Kalmar County Hospital, Kalmar, Sweden
| | - Bo Larsson
- Regional Center for Child and Youth Mental Health and Child Welfare – Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
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131
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Darnall BD, Ziadni MS, Roy A, Kao MC, Sturgeon JA, Cook KF, Lorig K, Burns JW, Mackey SC. Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial. Trials 2018; 19:165. [PMID: 29510735 PMCID: PMC5838852 DOI: 10.1186/s13063-018-2537-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/08/2018] [Indexed: 01/07/2023] Open
Abstract
Background The Institute of Medicine (IOM) reported that chronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Pain catastrophizing is a psychological construct shown to predict the development and trajectory of chronic pain and patient response to pain treatments. While effective treatment for pain catastrophizing typically includes eight-session groups of cognitive behavioral therapy (CBT), a single-session targeted treatment class yielded promising results which, if replicated and extended, could prove to efficiently and cost-effectively reduce pain catastrophizing. In this trial, we seek to determine the comparative efficacy of this novel single-session pain catastrophizing class to an eight-session course of pain CBT and a single-session back pain health education class. We will also explore the psychosocial mechanisms and outcomes of pain catastrophizing treatment. Methods In this trial we will randomize 231 individuals with CLBP to one of three treatment arms: (1) pain-CBT (eight weekly 2-h group sessions with home exercises and readings); (2) a single 2-h pain catastrophizing class; or (3) a single 2-h back pain health education class (active control). For the primary outcome of pain catastrophizing, the trial is designed as a non-inferiority test between pain-CBT and the single-session pain catastrophizing class, and as a superiority test between the single-session pain catastrophizing class and the health education class. Team researchers masked to treatment assignment will assess outcomes up to six months post treatment. Discussion If the single-session targeted pain catastrophizing class is found to be an effective treatment for patients with CLBP, this low cost and low burden treatment could dismantle many of the current barriers and burdens of effective pain care. Further, elucidation of the mechanisms of pain catastrophizing treatments will facilitate future research on the topic as well as further development and refinement of treatments. Trial registration ClinicalTrials.gov, NCT03167086. Registered on 22 May 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2537-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA.
| | - Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Anuradha Roy
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Ming-Chih Kao
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - John A Sturgeon
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Karon F Cook
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Kate Lorig
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
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132
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Adams LM, Turk DC. Central sensitization and the biopsychosocial approach to understanding pain. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/jabr.12125] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Leah M. Adams
- Department of Psychology; George Mason University; Fairfax VA
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine; University of Washington; Seattle WA
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133
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How Can We Best Reduce Pain Catastrophizing in Adults With Chronic Noncancer Pain? A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2018; 19:233-256. [DOI: 10.1016/j.jpain.2017.09.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 12/18/2022]
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134
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Abstract
OBJECTIVES It is not known whether psychosocial chronic pain treatments produce benefits through the unique mechanisms specified by theory. Fundamental to gaining an accurate understanding of this issue is to first determine whether the most widely used process measures assess unique constructs and predict unique variance in pain outcomes. This study examined the associations between the Pain Catastrophizing Scale (PCS), Five-Facet Mindfulness Questionnaire (FFMQ-SF), and the Chronic Pain Acceptance Questionnaire (CPAQ-8), and determined their unique contributions to the prediction of pain intensity, pain interference, and depression. METHODS A cross-sectional study was conducted with undergraduate students (N=260) reporting chronic or intermittent pain. Correlations, regression models, and multiple mediation models were performed. Relevant covariates were included. RESULTS The PCS, FFMQ-SF scales, and CPAQ-8 were correlated in mostly expected directions, but not so highly as to indicate redundancy. The PCS significantly predicted pain intensity, interference, and depression. The FFMQ-SF Observing and Describing scales predicted pain intensity; Nonreactivity and Nonjudging significantly predicted interference and depression, respectively. The CPAQ-8 was not a significant predictor in any of the regression models. The PCS was a comparatively stronger mediator than the FFMQ-SF scales in the intensity to interference, and intensity to depression mediation models. DISCUSSION The findings indicate that pain catastrophizing, mindfulness, and pain acceptance are related, but unique constructs. The PCS and select FFMQ-SF scales were uniquely associated with the criterion measures. However, the PCS emerged as the most robust process, highlighting the importance of targeting this cognitive domain in streamlining pain treatments to optimize outcome.
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135
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Ruben MA, Meterko M, Bokhour BG. Do patient perceptions of provider communication relate to experiences of physical pain? PATIENT EDUCATION AND COUNSELING 2018; 101:209-213. [PMID: 28803029 DOI: 10.1016/j.pec.2017.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Patient-provider communication is an important component of the medical interaction yet little research has examined the relationships between perceptions of communication and health outcomes or the mechanisms by which communication may ameliorate the pain experience. This is the first study to examine the relationships between patients' perceptions of provider communication, pain intensity and self-efficacy for managing chronic disease. METHODS The total sample contained 1027 (85.8% male) Veteran patients. Patients responded to surveys about their experiences and outcomes of care, including measures of patient-provider communication, self-efficacy and pain outcomes including pain intensity and pain interference. RESULTS Results showed more positive perceptions of provider communication were related to lower levels of pain intensity and pain interference and that this relationship was significantly mediated by higher levels of self-efficacy for managing chronic disease. CONCLUSION More positive provider communication was related to higher levels of self-efficacy, which in turn was related to lower levels of pain intensity and pain interference. Findings suggest that providers may be able to elicit higher levels of self-efficacy in their patients by providing patient-centered communication, which in turn will reduce pain intensity and interference in their patient's lives.
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Affiliation(s)
- Mollie A Ruben
- School of Arts & Sciences, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, United States; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, United States.
| | - Mark Meterko
- Department of Health Law, Policy and Management, Boston University School of Public Health, United States; Performance Measurement, VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID - 10EA), United States
| | - Barbara G Bokhour
- Department of Health Law, Policy and Management, Boston University School of Public Health, United States; Center for Healthcare Organization and Implementation Research, VA New England Healthcare System, United States
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136
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Nicholls JL, Azam MA, Burns LC, Englesakis M, Sutherland AM, Weinrib AZ, Katz J, Clarke H. Psychological treatments for the management of postsurgical pain: a systematic review of randomized controlled trials. Patient Relat Outcome Meas 2018; 9:49-64. [PMID: 29403322 PMCID: PMC5783145 DOI: 10.2147/prom.s121251] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Inadequately managed pain is a risk factor for chronic postsurgical pain (CPSP), a growing public health challenge. Multidisciplinary pain-management programs with psychological approaches, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based psychotherapy, have shown efficacy as treatments for chronic pain, and show promise as timely interventions in the pre/perioperative periods for the management of PSP. We reviewed the literature to identify randomized controlled trials evaluating the efficacy of these psychotherapy approaches on pain-related surgical outcomes. MATERIALS AND METHODS We searched Medline, Medline-In-Process, Embase and Embase Classic, and PsycInfo to identify studies meeting our search criteria. After title and abstract review, selected articles were rated for risk of bias. RESULTS Six papers based on five trials (four back surgery, one cardiac surgery) met our inclusion criteria. Four papers employed CBT and two CBT-physiotherapy variant; no ACT or mindfulness-based studies were identified. Considerable heterogeneity was observed in the timing and delivery of psychological interventions and length of follow-up (1 week to 2-3 years). Whereas pain-intensity reporting varied widely, pain disability was reported using consistent methods across papers. The majority of papers (four of six) reported reduced pain intensity, and all relevant papers (five of five) found improvements in pain disability. General limitations included lack of large-scale data and difficulties with blinding. CONCLUSION This systematic review provides preliminary evidence that CBT-based psychological interventions reduce PSP intensity and disability. Future research should further clarify the efficacy and optimal delivery of CBT and newer psychological approaches to PSP.
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Affiliation(s)
- Judith L Nicholls
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital
| | - Muhammad A Azam
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital
- Department of Psychology, York University
| | - Lindsay C Burns
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital
- Department of Psychology, York University
| | | | - Ainsley M Sutherland
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital
| | - Aliza Z Weinrib
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital
- Department of Psychology, York University
| | - Joel Katz
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital
- Department of Psychology, York University
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
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137
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Abstract
OBJECTIVES Cognitive functioning is commonly disrupted in people living with chronic pain, yet it is an aspect of pain that is often not routinely assessed in pain management settings, and there is a paucity of research on treatments or strategies to alleviate the problem. The purpose of this review is to outline recent research on cognitive deficits seen in chronic pain, to give an overview of the mechanisms involved, advocate cognitive functioning as an important target for treatment in pain populations, and discuss ways in which it may be assessed and potentially remediated. METHODS A narrative review. RESULTS There are several options for remediation, including compensatory, restorative, and neuromodulatory approaches to directly modify cognitive functioning, as well as physical, psychological, and medication optimization methods to target secondary factors (mood, sleep, and medications) that may interfere with cognition. DISCUSSION We highlight the potential to enhance cognitive functions and identify the major gaps in the research literature.
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138
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Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses. Clin J Pain 2017; 32:763-72. [PMID: 26550959 DOI: 10.1097/ajp.0000000000000320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The results of a recently performed randomized clinical trial showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness (BA), catastrophizing, and depression was improved by adding psychomotor therapy (PMT), an intervention targeting BA. No significant effects were found on quality of life and disability. The present follow-up study aimed to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated. METHODS In total, 94 patients with chronic pain participated in a randomized clinical trial comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability, and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analyzed by linear mixed-model analysis. RESULTS Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy, catastrophizing, or both. In the regression model with depression as the outcome variable, the regression coefficient of treatment (ie, PMT vs. TAU) decreased by 34% and became nonsignificant when BA was added as a potential mediator. Patients with low BA seemed to benefit more from PMT than patients with high BA, especially on depression, BA, and catastrophizing. CONCLUSIONS BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that seems to provide its benefits through improving BA and may be especially beneficial for patients with low BA.
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139
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Åkerblom S, Perrin S, Rivano Fischer M, McCracken LM. The Impact of PTSD on Functioning in Patients Seeking Treatment for Chronic Pain and Validation of the Posttraumatic Diagnostic Scale. Int J Behav Med 2017; 24:249-259. [PMID: 28194719 PMCID: PMC5344943 DOI: 10.1007/s12529-017-9641-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose The purpose of this study was to assess the psychometric properties of a Swedish version of the Posttraumatic Diagnostic Scale (PDS); to investigate the prevalence of traumatic experiences, trauma types, and posttraumatic stress disorder (PTSD) in a sample of patients seeking treatment for chronic pain; and to examine how indices of pain-related functioning vary with a history of traumatic exposure and PTSD diagnostic status. Method Participants were 463 consecutive patients with chronic pain referred for assessment at the Pain Rehabilitation Unit at Skåne University Hospital. Results The translated version of the PDS demonstrated high levels of internal consistency and a factor structure similar to that reported in previous validation studies using samples identified because of trauma exposure (not chronic pain), both of which provide preliminary support for the validity of this translated version. Based on their responses to the PDS, most patients (71.8%) reported one or more traumatic events with 28.9% fulfilling criteria for a current PTSD diagnosis. The patients with PTSD also reported significantly higher levels of pain interference, kinesiophobia, anxiety, and depression and significantly lower levels of life control, compared to patients exposed to trauma and not fulfilling criteria for PTSD and patients with no history of traumatic exposure. Conclusion Consistent with previous research, a significant proportion of patients seeking treatment for chronic pain reported a history of traumatic exposure and nearly one third of these met current criteria for PTSD according to a standardized self-report measure. The presence of PTSD was associated with multiple indictors of poorer functioning and greater treatment need and provides further evidence that routine screening of chronic pain patients for PTSD is warranted. Self-report measures like the PDS appear to be valid for use in chronic pain samples and offer a relative low-cost method for screening for PTSD.
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Affiliation(s)
- Sophia Åkerblom
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden. .,Department of Psychology, Lund University, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Marcelo Rivano Fischer
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Lance M McCracken
- Psychology Department, Health Psychology Section, King's College London, London, UK
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140
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Wang W, Wang F, Fan F, Sedas AC, Wang J. Mind-Body Interventions for Irritable Bowel Syndrome Patients in the Chinese Population: a Systematic Review and Meta-Analysis. Int J Behav Med 2017; 24:191-204. [PMID: 27646279 DOI: 10.1007/s12529-016-9589-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study is to identify and assess evidence related to the efficacy of mind-body interventions on irritable bowel syndrome (IBS) in the Chinese population. METHOD Drawn from Chinese databases, nine RCTs and three Q-E studies were included in the systematic review. The methodological quality of RCTs was evaluated based on the following criteria: adequate sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other potential biases. For continuous variables, the effect size (ES) was determined by calculating the standardized mean difference between groups. For dichotomous variables, the ES was determined by calculating the risk ratio (RR) between groups. Given the heterogeneity between the trials and the small number of studies included, both random effects and fixed effects models were used. The inverse variance method was used for pooling. Statistical analyses were performed using Review Manager version 5.0. RESULTS The total number of papers identified was 710: 462 from English language databases and 248 from Chinese language databases. Twelve studies met our eligibility criteria. Among the studies selected, three were Q-E studies the rest RCTs. Two studies described the randomization process. None of the studies reported allocation concealment nor blinding. Seven studies reported no dropouts. One of the studies mentioned the total amount of dropouts; though the reason for dropping out was not referenced. The other four studies did not clearly report dropouts. With the exception of three studies, there was inadequate information to determine biased reporting for the majority; the level of risk for bias in these studies is unclear. Finally, six meta-analyses were performed. One was conducted with four randomized controlled trials (RCTs) that used cure rate as outcome measures to evaluate gastrointestinal (GI) symptoms, which suggested that mind-body interventions were effective in improving GI symptoms (random effects model: RR = 1.08; 95 % CI 1.01 to 1.17; fixed effects model: RR = 1.07; 95 % CI 1.01 to 1.12). The remaining five were conducted in three RCTs, which suggested that mind-body interventions were effective in improving several aspects of quality of life, including interference with activity (random effects and fixed effects models: SMD = 0.64; 95 % CI 0.41 to 0.86), body image (random effects model: SMD = 0.36; 95 % CI 0.06 to 0.67; fixed effects model: SMD = 0.33; 95 % CI 0.11 to 0.55), health worry (random effects and fixed effects models: SMD = 0.67; 95 % CI 0.44 to 0.90), food avoidance (random effects and fixed effects models: SMD = 0.45; 95 % CI 0.23 to 0.68), and social reaction (random effects model: SMD = 0.79; 95 % CI 0.47 to 1.12; fixed effects model: SMD = 0.78; 95 % CI 0.55 to 1.01), as measured by Irritable Bowel Syndrome Quality of Life Questionnaire ( IBS-QOL). CONCLUSION Mind-body interventions may have the potential to improve GI symptoms in Chinese patients with IBS. The improvement of GI symptoms was also accompanied with the improvement of various outcomes, including depression, anxiety, and quality of life, just to mention a few. However, the published studies generally had significant methodological limitations. Future clinical trials with rigorous research design are needed in this field. More studies focusing on the mind-body interventions originated in China, such as tai chi and qi gong should be encouraged.
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Affiliation(s)
- Weidong Wang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, 5, Beixiange Street, Xicheng District, Beijing, 100053, China
| | - Fang Wang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, 5, Beixiange Street, Xicheng District, Beijing, 100053, China.
| | - Feng Fan
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, 5, Beixiange Street, Xicheng District, Beijing, 100053, China
| | - Ana Cristina Sedas
- Benson-Henry Institute for Mind Body Medicine of Massachusetts General Hospital, Boston, MA, USA
| | - Jian Wang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, 5, Beixiange Street, Xicheng District, Beijing, 100053, China
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141
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Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain 2017; 157:2434-2444. [PMID: 27257859 DOI: 10.1097/j.pain.0000000000000635] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cognitive behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with chronic low back pain (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (nonreactivity, nonjudging, and acting with awareness; all P values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P values <0.05) measures. Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the subsample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain.
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142
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Åkerblom S, Perrin S, Fischer MR, McCracken LM. A Validation and Generality Study of the Committed Action Questionnaire in a Swedish Sample with Chronic Pain. Int J Behav Med 2017; 23:260-270. [PMID: 26846475 DOI: 10.1007/s12529-016-9539-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Psychological flexibility is the theoretical model that underpins Acceptance Commitment Therapy (ACT). There is a growing body of evidence indicating that ACT is an effective treatment for chronic pain but one component of the model, committed action, has not been sufficiently researched. The purpose of this study is to validate Swedish-language versions of the full length Committed Action Questionnaire (CAQ; CAQ-18) and the shortened CAQ (CAQ-8), to examine the generality of previous results related to committed action and to further demonstrate the relevance of this construct to the functioning of patients with chronic pain. METHOD The study includes preliminary analyses of the reliability and validity of the CAQ. Participants were 462 consecutive referrals to the Pain Rehabilitation Unit at Skåne University Hospital. RESULTS The Swedish-language versions of the CAQ (CAQ-18 and CAQ-8) demonstrated high levels of internal consistency and satisfactory relationships with various indices of patient functioning and theoretically related concepts. Confirmatory factor analyses showed that the Swedish versions of the CAQ yielded similar two-factor models as found in the original validation studies. Hierarchical regression analyses identified the measures as significant contributors to explained variance in patient functioning. CONCLUSION The development, translation and further validation of the CAQ is an important step forward in evaluating the utility of the psychological flexibility model to the treatment of chronic pain. The CAQ can both assist researchers interested in mediators of chronic pain treatment and further enable research on change processes within the psychological flexibility model.
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Affiliation(s)
- Sophia Åkerblom
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden. .,Department of Psychology, Lund University, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Marcelo Rivano Fischer
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Lance M McCracken
- Psychology Department, Health Psychology Section, King's College London, London, UK
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143
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Gilpin HR, Keyes A, Stahl DR, Greig R, McCracken LM. Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review. THE JOURNAL OF PAIN 2017; 18:1153-1164. [PMID: 28455249 DOI: 10.1016/j.jpain.2017.04.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 02/07/2023]
Abstract
There is increasing evidence that contextual forms of cognitive-behavioral therapy (CBT) are effective in the management of chronic pain, yet little is understood about the factors that moderate or predict outcomes in these treatments. This systematic review aimed to identify pretreatment participant characteristics associated with positive treatment responses in contextual CBT for chronic pain. Medline, EMBASE, PsychINFO, and CENTRAL were searched to identify eligible studies. Studies were included if the participants were adults with chronic pain, designs were longitudinal, treatments focused on psychological flexibility or mindfulness, and reported results allowed for examination of moderators or predictors of standard treatment outcomes. Of 991 records initially identified, 20 were eligible for inclusion in the review. Some evidence suggested that baseline emotional functioning predicts treatment response, but the direction of this association varied between studies. Substantive findings were inconsistent and inconclusive, however, methodological limitations were consistent. These included treatment heterogeneity, and a lack of theoretical, a priori guidance in examining potential predictors. Future research should adopt a theoretically based approach to examining moderators in relation to specific treatment methods and therapeutic processes. Considering moderation without first considering mediation is probably a limited strategy. PERSPECTIVE In this systematic review we examined evidence for potential predictors or moderators of outcomes in contextual CBT for chronic pain. Substantive findings were inconclusive but important methodological limitations and a lack of theoretical guidance were found. Future research should explicitly plan relevant methods and follow clear theoretical models.
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Affiliation(s)
- Helen R Gilpin
- INPUT Pain Management, Guys and St Thomas NHS Foundation Trust Hospitals, London, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Alexandra Keyes
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Daniel R Stahl
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Riannon Greig
- Royal Holloway, University of London, United Kingdom
| | - Lance M McCracken
- INPUT Pain Management, Guys and St Thomas NHS Foundation Trust Hospitals, London, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
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144
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Paterson LQP, Handy AB, Brotto LA. A Pilot Study of Eight-Session Mindfulness-Based Cognitive Therapy Adapted for Women's Sexual Interest/Arousal Disorder. JOURNAL OF SEX RESEARCH 2017; 54:850-861. [PMID: 27712106 DOI: 10.1080/00224499.2016.1208800] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While few treatment options exist for low sexual desire and arousal, the most common sexual dysfunction in women, a growing body of research supports the efficacy of mindfulness-based approaches. The mechanisms underlying improvements, and whether they are due to mindfulness practice or other treatment components, are unclear. As a result, we designed and pilot-tested an eight-session group mindfulness-based cognitive therapy for sexuality (MBCT-S) program that includes more extensive practice of mindfulness skills and closely aligns with the evidence-based MBCT program for depression and anxiety. A total of 26 women (mean age 43.9, range 25 to 63) with a diagnosis of sexual interest/arousal disorder participated in eight weekly group sessions, before and after which they completed validated questionnaires. The majority of women attended all sessions and completed the recommended at-home mindfulness exercises. Compared to baseline, women reported significant improvements in sexual desire, overall sexual function, and sex-related distress, regardless of treatment expectations, relationship duration, or low desire duration. Depressed mood and mindfulness also significantly improved and mediated increases in sexual function. These pilot data suggest that eight-session MBCT-S is feasible and significantly improves sexual function, and provide the basis for a larger randomized-controlled trial (RCT) with a longer follow-up period.
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Affiliation(s)
| | - Ariel B Handy
- b Department of Psychology , University of Texas at Austin
| | - Lori A Brotto
- c Department of Obstetrics and Gynaecology , University of British Columbia , Vancouver
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145
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Harrison AM, McCracken LM, Jones K, Norton S, Moss-Morris R. Using mixed methods case-series evaluation in the development of a guided self-management hybrid CBT and ACT intervention for multiple sclerosis pain. Disabil Rehabil 2017; 39:1785-1798. [PMID: 27557625 DOI: 10.1080/09638288.2016.1209580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Two-thirds of the people with multiple sclerosis (pwMS) experience pain. Medications provide minimal relief, and current non-pharmacological interventions lack a clear conceptualization of MS pain. This study explored the potential efficacy of a telephone-supported hybrid cognitive behavior therapy and acceptance and commitment therapy self-management intervention for pwMS based on an empirically supported model of MS pain using a replicated single-case series design. METHODS Seven pwMS with varied demographic and disease characteristics completed the 8-week home-based program alongside 3 hours of telephone support. Online questionnaires were completed every four days for 16 weeks (4-weeks baseline, 8-weeks treatment, 4-weeks follow-up). The primary outcomes were pain severity and pain interference. Psychological process variables drawn from the MS pain model were also completed, and post-treatment qualitative interviews conducted. RESULTS Simulation modeling analysis (SMA) showed three patients had large improvements in pain outcomes, two showed no change and two worsened. Five participants showed significant change on various psychological process variables. Change in pain catastrophizing was the most consistent finding. CONCLUSIONS The findings suggest a self-management program for MS pain with minimal therapy support may be effective for some pwMS, but not those with more complex comorbidities. The participants suggested web-based delivery may simplify the approach, and therapist telephone contact was highly valued. Implications for Rehabilitation This case series suggests a hybrid CBT/ACT self-management workbook program for MS pain improves severity and impact of pain in some pwMS. Pain-related catastrophizing reduced in most pwMS, whilst change in other ACT and CBT process variables varied across the individuals. PwMS feedback suggests a tailored web-based delivery of the program with therapist telephone support may be optimal. PwMS with serious co-morbid depression and very advanced disease may not respond well to this self-management approach.
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Affiliation(s)
- Anthony M Harrison
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Lance M McCracken
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Katherine Jones
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Sam Norton
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Rona Moss-Morris
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
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146
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Coronado RA, Bird ML, Van Hoy EE, Huston LJ, Spindler KP, Archer KR. Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review. Clin Rehabil 2017; 32:287-298. [DOI: 10.1177/0269215517728562] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mackenzie L Bird
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin E Van Hoy
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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147
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Durá-Ferrandis E, Ferrando-García M, Galdón-Garrido MJ, Andreu-Vaillo Y. Confirming the mechanisms behind cognitive-behavioural therapy effectiveness in chronic pain using structural equation modeling in a sample of patients with temporomandibular disorders. Clin Psychol Psychother 2017; 24:1377-1383. [PMID: 28804935 DOI: 10.1002/cpp.2114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/18/2017] [Accepted: 06/18/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate whether therapeutic mechanisms assumed to explain the effect of cognitive behavioural therapy (CBT) concerning temporomandibular symptoms are confirmed by structural equation modelling. METHOD Patients were randomly assigned to either an experimental group receiving CBT (N = 41) or a standard therapy control group (N = 31). Subjects were assessed before and after intervention using mediator variables hypothesized according to the CBT model, as well as outcome variables and other socio-demographic and clinical measures. RESULTS The results confirm that the effect of treatment on pain intensity was partially mediated by distress, catastrophizing, perceived control, distraction, and mental self-control. The self-medication frequency was partially mediated by distraction. Pain interference was partially mediated by distress, distraction, and mental self-control. Reduction in the number of painful points on palpation was partially explained by distress, although in this case, there was a significant direct effect of treatment not mediated by other variables. CONCLUSIONS The results could set the principles for the development of more efficient and effective cognitive behavioural interventions for chronic pain.
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Affiliation(s)
| | - Maite Ferrando-García
- Personality, Assessment and Psychological Treatments, Universitat de Valencia, Valencia, Spain
| | - Mª José Galdón-Garrido
- Personality, Assessment and Psychological Treatments, Universitat de Valencia, Valencia, Spain
| | - Yolanda Andreu-Vaillo
- Personality, Assessment and Psychological Treatments, Universitat de Valencia, Valencia, Spain
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148
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Day MA, Brinums M, Craig N, Geffen L, Geffen S, Lovai M, Geffen G. Predictors of Responsivity to Interdisciplinary Pain Management. PAIN MEDICINE 2017; 19:1848-1861. [DOI: 10.1093/pm/pnx169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Melissa A Day
- School of Psychology
- Brisbane Pain Rehabilitation Service, Brisbane, Australia
| | - Melissa Brinums
- School of Psychology
- Brisbane Pain Rehabilitation Service, Brisbane, Australia
| | - Nathan Craig
- School of Health and Rehabilitation Sciences
- Brisbane Pain Rehabilitation Service, Brisbane, Australia
| | - Laurence Geffen
- Brisbane Pain Rehabilitation Service, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Saul Geffen
- School of Health and Rehabilitation Sciences
- Brisbane Pain Rehabilitation Service, Brisbane, Australia
| | - Miriam Lovai
- Brisbane Pain Rehabilitation Service, Brisbane, Australia
| | - Gina Geffen
- Brisbane Pain Rehabilitation Service, Brisbane, Australia
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149
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McAndrew LM, Greenberg LM, Ciccone DS, Helmer DA, Chandler HK. Telephone-Based versus In-Person Delivery of Cognitive Behavioral Treatment for Veterans with Chronic Multisymptom Illness: A Controlled, Randomized Trial. MILITARY BEHAVIORAL HEALTH 2017; 6:56-65. [PMID: 31192051 PMCID: PMC6561490 DOI: 10.1080/21635781.2017.1337594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The goal of this randomized clinical trial was to examine the efficacy of a cognitive behavioral stress reduction treatment for reducing disability among veterans with chronic multisymptom illness (CMI). METHOD Veterans (N=128) who endorsed symptoms of CMI were randomized to: usual care (n=43), in-person (n=42) or telephone-delivered cognitive behavioral stress management (n=43). Assessments were conducted at baseline, three months, and twelve months. The primary outcome was limitation in roles at work and home (i.e., 'role physical'). Reductions in catastrophizing cognitions were evaluated as a mechanism of action. RESULTS Intent-to-treat analyses showed no statistically significant main effect (F(2, 164)=.58, p=.56) or interaction effect (F(4,164)=.94, p=.45) for role physical. Over time, veterans improved in their physical function (F(2,170)=5.34, p<.01; ὴ2 partial=.06), PTSD symptoms (F(2,170)=9.39, p<.01; ὴ2 partial=.10), depressive symptoms (F(2,170)=10.81, p<.01, ὴ2 partial=.11), and physical symptoms (F(2, 172)=12.65, p<.01; ὴ2 partial=.13), but these improvements did not differ across study arms over time. Completer analyses yielded similar results. There were no differences in catastrophizing between arms. CONCLUSION Findings suggest stress reduction may not be the right target for improving disability among veterans with CMI. Veterans with CMI may need intervention that directly impacts medical self-management to improve disability.
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Affiliation(s)
- Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, U. S. A
| | - Lauren M Greenberg
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
| | - Donald S Ciccone
- Department of Psychiatry, New Jersey Medical School, Rutgers University, Newark, NJ, U. S. A
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
- Department of Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, U. S. A
| | - Helena K Chandler
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
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150
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Arora N, Brotto LA. How Does Paying Attention Improve Sexual Functioning in Women? A Review of Mechanisms. Sex Med Rev 2017; 5:266-274. [DOI: 10.1016/j.sxmr.2017.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 01/01/2023]
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