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Donath C, Luttenberger K, Geiß C, Albert P, Fraunberger B. Chronic headache patients' health behavior and health service use 12 months after interdisciplinary treatment - what do they keep in their daily routines? BMC Neurol 2022; 22:149. [PMID: 35448981 PMCID: PMC9022266 DOI: 10.1186/s12883-022-02646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background We do not yet know whether or the extent to which multimodal therapy changes the health behaviors and health service use of chronic headache patients in the long term. Associations are expected between pain symptoms and pain management abilities for patients who are categorized as successfully treated and those who remain unchanged. Methods Routine longitudinal data of an enrolment period of five years from 101 headache patients treated with a two-week, full-day, semi-inpatient multimodal pain therapy at the Interdisciplinary Pain Center of the University Clinic Erlangen were available when therapy began and 12 months after treatment. To investigate long-term changes in health behavior and health service use as well as their associations with the outcome “reduction in pain days,” we used descriptive and inferential statistics (i.e., binary logistic regression). Results Patients who underwent interdisciplinary treatment showed statistically significant changes in their health behavior in five areas. Twelve months after treatment, we found a significantly higher frequency of engagement in athletic sports (p < .001) as well as increases in the use of relaxation techniques (p < .001), TENS devices for relaxation purposes (p = .008), psychological coping strategies (p < .001), and mindfulness-based techniques for dealing with pain (p < .001). 52.8% of the sample reported a reduction in the number of pain days 12 months after treatment. Binary logistic regression (χ2 (12) = 21.419; p = .045; R2 = .255) revealed that a reduction in pain days 12 months after treatment was positively associated with regular physical activity in the form of muscle strengthening and stretching (athletic sports) (p = .012). Conclusion Chronic headache patients acquired long-term skills from an interdisciplinary treatment concerning the use of relaxation techniques, the use of psychological coping strategies, and physical activity in the form of athletic exercise. Of those, regular athletic exercise was positively associated with a smaller number of pain days in the long term. Thus, a physical activity module should be an element of interdisciplinary treatment for chronic headache patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02646-w.
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Affiliation(s)
- Carolin Donath
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Center for Health Services Research in Medicine, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Katharina Luttenberger
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Center for Health Services Research in Medicine, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christa Geiß
- Interdisciplinary Pain Center, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Patricia Albert
- Interdisciplinary Pain Center, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Britta Fraunberger
- Interdisciplinary Pain Center, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Germany
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Moore CS, Sibbritt DW, Adams J. A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurol 2017; 17:61. [PMID: 28340566 PMCID: PMC5364599 DOI: 10.1186/s12883-017-0835-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/13/2017] [Indexed: 12/23/2022] Open
Abstract
Background Despite the expansion of conventional medical treatments for headache, many sufferers of common recurrent headache disorders seek help outside of medical settings. The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population. Methods This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motivations, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders. Results While available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches. The most common reason for choosing this type of treatment was seeking pain relief. While a high percentage of these patients likely continue with concurrent medical care, around half may not be disclosing the use of this treatment to their medical doctor. Conclusions There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache. Primary healthcare providers should be mindful of the use of this highly popular approach to headache management in order to help facilitate safe, effective and coordinated care.
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Affiliation(s)
- Craig S Moore
- University of Technology Sydney, Faculty of Health, Building 10, Level 8, 235-253 Jones St, Ultimo, Sydney, NSW, 2007, Australia.
| | - David W Sibbritt
- University of Technology Sydney, Faculty of Health, Building 10, Level 8, 235-253 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Jon Adams
- University of Technology Sydney, Faculty of Health, Building 10, Level 8, 235-253 Jones St, Ultimo, Sydney, NSW, 2007, Australia
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Pombo N, Garcia N, Bousson K, Spinsante S, Chorbev I. Pain Assessment--Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:415. [PMID: 27089351 PMCID: PMC4847077 DOI: 10.3390/ijerph13040415] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/29/2016] [Accepted: 04/07/2016] [Indexed: 01/17/2023]
Abstract
Background: Mobile and web technologies are becoming increasingly used to support the treatment of chronic pain conditions. However, the subjectivity of pain perception makes its management and evaluation very difficult. Pain treatment requires a multi-dimensional approach (e.g., sensory, affective, cognitive) whence the evidence of technology effects across dimensions is lacking. This study aims to describe computerised monitoring systems and to suggest a methodology, based on statistical analysis, to evaluate their effects on pain assessment. Methods: We conducted a review of the English-language literature about computerised systems related to chronic pain complaints that included data collected via mobile devices or Internet, published since 2000 in three relevant bibliographical databases such as BioMed Central, PubMed Central and ScienceDirect. The extracted data include: objective and duration of the study, age and condition of the participants, and type of collected information (e.g., questionnaires, scales). Results: Sixty-two studies were included, encompassing 13,338 participants. A total of 50 (81%) studies related to mobile systems, and 12 (19%) related to web-based systems. Technology and pen-and-paper approaches presented equivalent outcomes related with pain intensity. Conclusions: The adoption of technology was revealed as accurate and feasible as pen-and-paper methods. The proposed assessment model based on data fusion combined with a qualitative assessment method was revealed to be suitable. Data integration raises several concerns and challenges to the design, development and application of monitoring systems applied to pain.
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Affiliation(s)
- Nuno Pombo
- Instituto de Telecomunicações (Telecommunications Institute), University of Beira Interior, Covilhã 6200-001, Portugal.
- Department of Informatics, University of Beira Interior, Covilhã 6200-001, Portugal.
- ALLab-Assisted Living Computing and Telecommunications Laboratory, University of Beira Interior, Covilhã 6200-001, Portugal.
| | - Nuno Garcia
- Instituto de Telecomunicações (Telecommunications Institute), University of Beira Interior, Covilhã 6200-001, Portugal.
- Department of Informatics, University of Beira Interior, Covilhã 6200-001, Portugal.
- ALLab-Assisted Living Computing and Telecommunications Laboratory, University of Beira Interior, Covilhã 6200-001, Portugal.
| | - Kouamana Bousson
- Department of Aerospace Sciences, University of Beira Interior, Covilhã 6200-001, Portugal.
| | - Susanna Spinsante
- Dipartimento di Ingegneria dell'Informazione, Università Politecnica delle Marche, Ancona 60121, Italy.
| | - Ivan Chorbev
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University Skopje, Skopje 1000, Macedonia.
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Abstract
Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4 h/day) are usually not included in CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.
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Costa A, Sansalone A, Squillace A, Vescio G, Iannacchero R. O007. Self-referred cognitive impairment in migraine patients. J Headache Pain 2015; 16:A149. [PMID: 28132239 PMCID: PMC4715071 DOI: 10.1186/1129-2377-16-s1-a149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Amerigo Costa
- Centre for Headache and Adaptive Disorders, Unit of Neurology, Department of Neuroscience and Sense Organs, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - Alessandra Sansalone
- Centre for Headache and Adaptive Disorders, Unit of Neurology, Department of Neuroscience and Sense Organs, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - Aida Squillace
- Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Vescio
- Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Rosario Iannacchero
- Centre for Headache and Adaptive Disorders, Unit of Neurology, Department of Neuroscience and Sense Organs, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy.
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Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society. Acta Neurol Belg 2015; 115:1-17. [PMID: 24968722 DOI: 10.1007/s13760-014-0313-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/13/2014] [Indexed: 12/24/2022]
Abstract
Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres.
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Dousset V, Maud M, Legoff M, Radat F, Brochet B, Dartigues JF, Kurth T. Probable medications overuse headaches: validation of a brief easy-to-use screening tool in a headache centre. J Headache Pain 2013; 14:81. [PMID: 24088386 PMCID: PMC3850931 DOI: 10.1186/1129-2377-14-81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To validate a rapid questionnaire as a screening tool, because application of the diagnostic revised criteria of the ICHD-II for medication overuse headache (MOH) requires experience for the physician and is time-consuming. METHODS ICHD-II criteria for probable MOH (pMOH) were transformed in questions formulated in such a way that they could be self-administered, easily understood, and quickly filled out. We compared this questionnaire to the gold standard: the diagnosis made by headache specialists, based on the the ICHD-II criteria. Patients who were consulting for pMOH or migraine for the first time were consecutively included. As validity indicators, we calculated sensitivity, specificity, positive and negative predictive values of the items. RESULTS Seventy-nine patients were screened, 77 included, 2 female patients excluded. Forty-two patients have been considered as suffering from pMOH, 35 patients suffered from migraine without medication overuse. The association of the question "do you take a treatment for attacks more than 10 days per month" and the question "is this intake on a regular basis?" had a sensitivity of 95.2% and a specificity of 80%. CONCLUSION This screening tool can detect pMOH with a sensitivity that could be of interest to screen patients in clinical practice and to pre-include patients for research as epidemiological studies.
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Affiliation(s)
- Virginie Dousset
- Centre Douleur Chronique, Hôpital Pellegrin, Place Amélie Raba Léon, 33 076 Bordeaux, Cedex, France.
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Wager J, Hechler T, Darlington A, Hirschfeld G, Vocks S, Zernikow B. Classifying the severity of paediatric chronic pain - an application of the chronic pain grading. Eur J Pain 2013; 17:1393-402. [DOI: 10.1002/j.1532-2149.2013.00314.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - S. Vocks
- Department of Psychology; Clinical Psychology and Psychotherapy; Osnabrück University; Germany
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Taylor FR, Landy SH, Kaniecki RG. Abstracts and Citations. Headache 2013. [DOI: 10.1111/head.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wallasch TM, Kropp P. Multidisciplinary integrated headache care: a prospective 12-month follow-up observational study. J Headache Pain 2012; 13:521-9. [PMID: 22790281 PMCID: PMC3444539 DOI: 10.1007/s10194-012-0469-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/21/2012] [Indexed: 11/26/2022] Open
Abstract
This prospective study investigated the effectiveness of a three-tier modularized out- and inpatient multidisciplinary integrated headache care program. N = 204 patients with frequent headaches (63 migraine, 11 tension-type headache, 59 migraine + tension-type headache, 68 medication-overuse headache and 3 with other primary headaches) were enrolled. Outcome measures at baseline, 6- and 12-month follow-ups included headache frequency, Migraine Disability Assessment (MIDAS), Hospital Anxiety and Depression Scale (HADS), standardized headache diary and a medication survey. Mean reduction in headache frequency was 5.5 ± 8.5 days/month, p < 0.001 at 6 months’ follow-up and 6.9 ± 8.3 days/month, p < 0.001 after 1 year. MIDAS decreased from 53.0 ± 60.8 to 37.0 ± 52.4 points, p < 0.001 after 6 months and 34.4 ± 53.2 points, p < 0.001 at 1 year. 44.0 % patients demonstrated at baseline an increased HAD-score for anxiety and 16.7 % of patients revealed a HAD-score indicating a depression. At the end of treatment statistically significant changes could be observed for anxiety (p < 0.001) and depression (p < 0.006). The intake frequency of attack-aborting medication decreased from 10.3 ± 7.3 days/month at admission to 4.7 ± 4.1 days/month, p < 0.001 after 6 months and reached 3.8 ± 3.5 days/month, p < 0.001 after 1 year. At baseline 37.9 % of patients had experience with non-pharmacological treatments and 87.0 % at 12-month follow-up. In conclusion, an integrated headache care program was successfully established. Positive health-related outcomes could be obtained with a multidisciplinary out- and inpatient headache treatment program.
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