The quantification inventory for somatoform syndromes (QUISS): a novel instrument for the assessment of severity

[Do pain therapy patients benefit from their fellow patients? : A retrospective observational study on the influence of the stage of pain management and therapy experience of fellow patients on the individual therapy success in an inpatient interdisciplinary multimodal pain therapy (IMPT)]

BACKGROUND

Interdisciplinary multimodal pain therapy (IMPT) is mostly run in a group setting to encourage the exchange of experiences between patients and thus facilitate the change of pain-related attitudes and behavior. As is known from psychotherapy research, the fellow patients in a therapy group have a relevant influence on the success of the therapy for the individual patient.

OBJECTIVE

We examined the extent to which therapy success in an IMST group is influenced by individual co-patient characteristics, such as cognitive behavioral pain management, the difference to their own pain management and the proportion of co-patients who repeat therapy.

METHOD

In a retrospectively planned investigation of the psychometric tests of all patients in an inpatient IMST between January 2013 and February 2020, the influence of fellow patient characteristics on clinically relevant changes with respect to various parameters of the severity of chronic pain disorders was analyzed using binary logistic regression analyses.

RESULTS

We examined 636 treatment cases of which 540 were first-time stays. On each day of treatment, 5 fellow patients were present, 15% of whom had repeated the therapy. We were able to show that the proportion of fellow patients who repeat the therapy (p < 0.001; odds ratio, OR = 1.032) and the cognitive behavioral pain management of the fellow patients (p < 0.001; OR = 2.885) significantly increase the probability of achieving success in at least one of the parameters examined. An influence of a specific parameter on the success of therapy could not be proven.

CONCLUSION

Despite methodological limitations our results suggest that in patient groups of an IMST, patients with therapy experience and those with advanced cognitive behavioral methods for pain management should be combined with novices and patients who are still at the beginning of coping with the chronic pain disorder.

Assessment of Somatization and Medically Unexplained Symptoms in Later Life

The assessment of medically unexplained symptoms and "somatic symptom disorders" in older adults is challenging due to somatic multimorbidity, which threatens the validity of somatization questionnaires. In a systematic review study, the Patient Health Questionnaire-15 (PHQ-15) and the somatization subscale of the Symptom Checklist 90-item version (SCL-90 SOM) are recommended out of 40 questionnaires for usage in large-scale studies. While both scales measure physical symptoms which in younger persons often refer to unexplained symptoms, in older persons, these symptoms may originate from somatic diseases. Using empirical data, we show that PHQ-15 and SCL-90 SOM among older patients correlate with proxies of somatization as with somatic disease burden. Updating the previous systematic review, revealed six additional questionnaires. Cross-validation studies are needed as none of 46 identified scales met the criteria of suitability for an older population. Nonetheless, specific recommendations can be made for studying older persons, namely the SCL-90 SOM and PHQ-15 for population-based studies, the Freiburg Complaint List and somatization subscale of the Brief Symptom Inventory 53-item version for studies in primary care, and finally the Schedule for Evaluating Persistent Symptoms and Somatic Symptom Experiences Questionnaire for monitoring treatment studies.

Cognitive-affective neuroscience of somatization disorder and functional somatic syndromes: reconceptualizing the triad of depression-anxiety-somatic symptoms

Somatization disorder is a somatoform disorder that overlaps with a number of functional somatic syndromes and has high comorbidity with major depression and anxiety disorders. Proposals have been made for revising the category of somatoform disorders, for simplifying the criteria for somatization disorder, and for emphasizing the unitary nature of the functional somatic syndromes in future classifications. A review of the cognitive-affective neuroscience of somatization disorder and related conditions suggests that overlapping psychobiological mechanisms mediate depression, anxiety, and somatization symptoms. Particular genes and environments may contribute to determining whether symptoms are predominantly depressive, anxious, or somatic, and there are perhaps also overlaps and distinctions in the distal evolutionary mechanisms that produce these symptoms.