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Forden G, Ronaghan S, Williams P, Fish S, Ford C. Predictors of treatment outcome in cognitive behavioural therapy for chronic pain: a systematic review. Disabil Rehabil 2024; 46:4877-4888. [PMID: 38018474 DOI: 10.1080/09638288.2023.2283113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The aim of this systematic review was to synthesise the research identifying possible influences on CBT outcomes in chronic pain. Variations in the effectiveness of psychological therapies, such as CBT, in chronic pain have led to research investigating predictors of improved treatment outcomes. MATERIALS AND METHODS We identified randomised controlled and cohort studies of CBT for chronic pain, published between 1974 to 2nd August 2023, which identified predictors of CBT outcomes. RESULTS Nineteen studies were included in the review. Baseline sociodemographic, physical and emotional factors that influence the outcomes of CBT for chronic pain were identified. The most commonly reported predictors of CBT outcome, with medium to large effect sizes, were anxiety, depression and negative cognitions about pain and coping. Sociodemographic predictors of outcomes demonstrated small effects and lacked replicability. CONCLUSIONS There was variability across study designs, CBT delivery and outcomes measures. Further research is needed in chronic pain to identify the predictive factors which influence treatment outcomes, and consistency across study designs and outcome variables is needed to reduce heterogeneity.
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Affiliation(s)
- Georgina Forden
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Ronaghan
- Psychological Medicine, Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarah Fish
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Catherine Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
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2
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Scholten S, Herzog P, Glombiewski JA, Kaiser T. Is personalization of psychological pain treatments necessary? Evidence from a Bayesian variance ratio meta-analysis. Pain 2024:00006396-990000000-00674. [PMID: 39106462 DOI: 10.1097/j.pain.0000000000003363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/29/2024] [Indexed: 08/09/2024]
Abstract
ABSTRACT This is the first study to empirically determine the potential for data-driven personalization in the context of chronic primary pain (CPP). Effect sizes of psychological treatments for individuals with CPP are small to moderate on average. Aiming for better treatment outcomes for the individual patient, the call to personalize CPP treatment increased over time. However, empirical evidence that personalization of psychological treatments can optimize treatment outcomes in CPP is needed. This study seeks to estimate heterogeneity of treatment effect for cognitive behavioral therapy (CBT) as the psychological treatment approach for CPP with the greatest evidence base. For this purpose, a Bayesian variance ratio meta-regression is conducted using updated data from 2 recently published meta-analyses with randomized controlled trials comparing CBT delivered face-to-face to treatment-as-usual or waiting list controls. Heterogeneity in patients with CPP would be reflected by a larger overall variance in the post-treatment score compared with the control group. We found first evidence for an individual treatment effect in CBT compared with the control group. The estimate for the intercept was 0.06, indicating a 6% higher variance of end point values in the intervention groups. However, this result warrants careful consideration. Further research is needed to shed light on the heterogeneity of psychological treatment studies and thus to uncover the full potential of data-driven personalized psychotherapy for patients with CPP.A Bayesian variance ratio meta-regression indicates empirical evidence that data-driven personalized psychotherapy for patients with chronic primary pain could increase effects of cognitive behavioral therapy.
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Affiliation(s)
- Saskia Scholten
- Pain and Psychotherapy Research Lab, Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| | - Philipp Herzog
- Pain and Psychotherapy Research Lab, Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Julia Anna Glombiewski
- Pain and Psychotherapy Research Lab, Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| | - Tim Kaiser
- Clinical Psychology and Psychotherapy, Universität Greifswald, Greifswald, Germany
- AE Methoden und Evaluation, Freie Universität Berlin, Berlin, Germany
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3
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Macgregor C, Blane DN, Tulle E, Campbell CL, Barber RJ, Hill O-Connor C, Seenan C. An ecosystem of accepting life with chronic pain: A meta-ethnography. Br J Pain 2024; 18:365-381. [PMID: 39092212 PMCID: PMC11289906 DOI: 10.1177/20494637241250271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.
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Affiliation(s)
- Cassandra Macgregor
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire, Chronic Pain Service, Coatbridge, UK
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emmanuelle Tulle
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Claire L Campbell
- NHS Fife, Pain Management Service, Queen Margaret Hospital, Dunfermline, UK
| | - Ruth J Barber
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire, Chronic Pain Service, Coatbridge, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Fife, Pain Management Service, Queen Margaret Hospital, Dunfermline, UK
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | | | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Ecija C, Gutierrez L, Catala P, Peñacoba C. Preference for Hedonic Goals in Fibromyalgia; Is It Always an Avoidance Mechanism? Looking the Relationship with Pain Acceptance from a Positive Psychology Perspective. Pain Manag Nurs 2024; 25:80-87. [PMID: 38129209 DOI: 10.1016/j.pmn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
The aim of this study was to analyze the effect of openness to experience on pain acceptance through positive affect (PA) considering the moderating role of preference for mood management goals in women with fibromyalgia (FM). A cross-sectional study (n = 231) was carried out. A simple mediation model and a moderate mediation model were conducted by SPSS macro-PROCESS. Results showed that PA mediated positively the effect of openness to experience on acceptance (B = 0.46, SE = 0.80, t = 5,59; 95% CI = [0.3016, 0.6298], p < .001) and that the contribution of openness to experience to PA varied at different values of mood management goals (medium: - .04; ß = .40, p < .001; high: .95; ß = .61, p<.001). Findings may serve as a foundation for tailored interventions to promote activity through acceptance focusing on PA and mood management goals among women with medium to high level of hedonic goals.
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Affiliation(s)
- Carmen Ecija
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lorena Gutierrez
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Cecilia Peñacoba
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
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Tiong K, Palmer GM, Jaaniste T. Attrition from Face-to-Face Pediatric Outpatient Chronic Pain Interventions: A Narrative Review and Theoretical Model. CHILDREN (BASEL, SWITZERLAND) 2024; 11:126. [PMID: 38275436 PMCID: PMC10814025 DOI: 10.3390/children11010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0-100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes.
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Affiliation(s)
- Kristen Tiong
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Greta M. Palmer
- Children’s Pain Management Service, Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Tiina Jaaniste
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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6
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Dear BF, Walker J, Karin E, Asrianti L, England J, Feliciano I, Bisby MA, Nielssen O, Kayrouz R, Cross S, Staples LG, Hadjistavropoulos HD, Titov N. Evaluation of a therapist-guided virtual psychological pain management program when provided as routine care: a prospective pragmatic cohort study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1372-1385. [PMID: 37540210 DOI: 10.1093/pm/pnad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Numerous randomized controlled trials have evaluated the outcomes of internet-delivered psychological pain management programs (PMPs) as a way of increasing access to care for people with chronic pain. However, there are few reports of the effectiveness of these PMPs when provided as part of routine care. METHODS The present study sought to report the clinical and demographic characteristics of users (n = 1367) and examine the effectiveness of an established internet-delivered psychological PMP program in improving several pain-related outcomes, when offered at a national digital mental health service over a 5-year period. It also sought to comprehensively explore predictors of treatment commencement, treatment completion, and clinical improvement. RESULTS Evidence of clinical improvements (% improvement; Hedges g) were found for all outcomes, including pain interference (18.9%; 0.55), depression (26.1%; 0.50), anxiety (23.9%; 0.39), pain intensity (12.8%; 0.41), pain self-efficacy (-23.8%; -0.46) and pain-catastrophizing (26.3%; 0.56). A small proportion of users enrolled but did not commence treatment (13%), however high levels of treatment completion (whole treatment = 63%; majority of the treatment = 75%) and satisfaction (very satisfied = 45%; satisfied = 37%) were observed among those who commenced treatment. There were a number of demographic and clinical factors associated with commencement, completion and improvement, but no decisive or dominant predictors were observed. DISCUSSION These findings highlight the effectiveness and acceptability of internet-delivered psychological PMPs in routine care and point to the need to consider how best to integrate these interventions into the pathways of care for people with chronic pain.
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Affiliation(s)
- Blake F Dear
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Jennie Walker
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Eyal Karin
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Lia Asrianti
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Jonathan England
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Ivy Feliciano
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Madelyne A Bisby
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Olav Nielssen
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Rony Kayrouz
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Shane Cross
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Lauren G Staples
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Nickolai Titov
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
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7
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Hollyfield S, Travers W, Sondh SK, Wilczek A, Jacobs C, McCracken LM, Scott W. An Observational Study of Outcomes Associated With Virtual Pain Management Programs Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic. Clin J Pain 2023; 39:524-536. [PMID: 37449794 PMCID: PMC10498868 DOI: 10.1097/ajp.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE In response to COVID-19, virtual, group-based interdisciplinary pain management programs (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low-intensity and pre-neuromodulation PMPs based on acceptance and commitment therapy as part of routine care during the pandemic. METHODS Depending on patients' needs, participants completed a virtual high-intensity or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 to 2019 for in-person residential ( n= 561), outpatient ( n =123), and pre-neuromodulation ( n =207) PMPs were also examined to provide a historical benchmark of performance. RESULTS The virtual high-intensity PMP ( n =294) showed significant improvements in all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP ( n =129). No statistically significant improvements were observed for the virtual low-intensity PMP ( n =90). The improvements associated with prepandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic. DISCUSSION These data provide preliminary support for the potential benefits of high, but not low, intensity virtual acceptance and commitment therapy-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.
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Affiliation(s)
| | - Warren Travers
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | | | - Angelika Wilczek
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | - Clair Jacobs
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | | | - Whitney Scott
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
- King’s College London, Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
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8
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McCracken LM. Personalized pain management: Is it time for process-based therapy for particular people with chronic pain? Eur J Pain 2023; 27:1044-1055. [PMID: 36755478 DOI: 10.1002/ejp.2091] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/08/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Psychological treatments for chronic pain have helped many people around the world. They are among the most researched and best evidenced treatments a person can receive when they have persistent, disabling and distressing pain. At the same time, improvements in the effectiveness of these treatments appear to be at a standstill. This may be due to an inherent lack of generalizability from aggregated group data to the individual, limited utility of our current schemes for categorizing people with pain conditions, faced with their inherent heterogeneity, our relatively coarse categories of treatment types and focus on treatment packages rather than individual methods, and our current failures to find adequate predictors of outcome, or to assign people their best-suited treatment methods, based on group data. In this review, it is argued that the development and examination of truly personalized treatment is a next logical step to create progress and improve the results people achieve. METHODS Key research studies pertaining to psychological treatments, treatment outcome, heterogeneity in chronic pain, prediction of treatment outcome, subtyping and treatment tailoring are reviewed. RESULTS AND CONCLUSION It is suggested that development of future treatments for chronic pain ought to incorporate an idiographic, process-based approach, focused on evidence-based mechanisms of change, individually and dynamically addressed, based on contextually sensitive ongoing assessment. Knowledge and practical solutions needed to make process-based therapy for chronic pain happen are discussed. SIGNIFICANCE Psychological approaches to chronic pain have been highly successful in the past but improvement in the effectiveness of these over time is slow to nonexistent. It is argued here that this has happened due to a failure to adequately consider the individual. Future psychological treatments for chronic pain ought to incorporate an idiographic, process-based approach, focused on evidence-based mechanisms of change, individually and dynamically addressed, grounded in ongoing contextually sensitive assessment.
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Affiliation(s)
- Lance M McCracken
- Division of Clinical Psychology, Psychology Department, Uppsala University, Uppsala, Sweden
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9
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Harrer M, Ebert DD, Kuper P, Paganini S, Schlicker S, Terhorst Y, Reuter B, Sander LB, Baumeister H. Predicting heterogeneous treatment effects of an Internet-based depression intervention for patients with chronic back pain: Secondary analysis of two randomized controlled trials. Internet Interv 2023; 33:100634. [PMID: 37635949 PMCID: PMC10457531 DOI: 10.1016/j.invent.2023.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 08/29/2023] Open
Abstract
Background Depression is highly prevalent among individuals with chronic back pain. Internet-based interventions can be effective in treating and preventing depression in this patient group, but it is unclear who benefits most from this intervention format. Method In an analysis of two randomized trials (N = 504), we explored ways to predict heterogeneous treatment effects of an Internet-based depression intervention for patients with chronic back pain. Univariate treatment-moderator interactions were explored in a first step. Multilevel model-based recursive partitioning was then applied to develop a decision tree model predicting individualized treatment benefits. Results The average effect on depressive symptoms was d = -0.43 (95 % CI: -0.68 to -0.17; 9 weeks; PHQ-9). Using univariate models, only back pain medication intake was detected as an effect moderator, predicting higher effects. More complex interactions were found using recursive partitioning, resulting in a final decision tree with six terminal nodes. The model explained a large amount of variation (bootstrap-bias-corrected R2 = 45 %), with predicted subgroup-conditional effects ranging from di = 0.24 to -1.31. External validation in a pilot trial among patients on sick leave (N = 76; R2 = 33 %) pointed to the transportability of the model. Conclusions The studied intervention is effective in reducing depressive symptoms, but not among all chronic back pain patients. Predictions of the multivariate tree learning model suggest a pattern in which patients with moderate depression and relatively low pain self-efficacy benefit most, while no benefits arise when patients' self-efficacy is already high. If corroborated in further studies, the developed tree algorithm could serve as a practical decision-making tool.
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Affiliation(s)
- Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - David Daniel Ebert
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Paula Kuper
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
- Clinical Psychology, Institute for Psychology, Humboldt University Berlin, Berlin, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Freiburg, Germany
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Sandra Schlicker
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Benedikt Reuter
- Clinical Psychology, Institute for Psychology, Humboldt University Berlin, Berlin, Germany
- Department Humanmedizin, Medical School Berlin, Berlin, Germany
| | - Lasse B. Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
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Haller K, Becker P, Niemeyer H, Boettcher J. Who benefits from guided internet-based interventions? A systematic review of predictors and moderators of treatment outcome. Internet Interv 2023; 33:100635. [PMID: 37449052 PMCID: PMC10336165 DOI: 10.1016/j.invent.2023.100635] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
To our knowledge, no systematic review has been conducted on predictors or moderators of treatment outcome across diagnoses in guided internet-based interventions (IBIs) for adults. To identify who benefits from this specific format and therein inform future research on improving patient-treatment fit, we aimed to aggregate results of relevant studies. 2100 articles, identified by searching the databases PsycInfo, Ovid Medline, and Pubmed and through snowballing, were screened in April/May 2021 and October 2022. Risk of bias and intra- and interrater reliability were assessed. Variables were grouped by predictor category, then synthesized using vote counting based on direction of effect. N = 60 articles were included in the review. Grouping resulted in 88 predictors/moderators, of which adherence, baseline symptoms, education, age, and gender were most frequently assessed. Better adherence, treatment credibility, and working alliance emerged as conclusive predictors/moderators for better outcome, whereas higher baseline scores predicted more reliable change but higher post-treatment symptoms. Results of all other predictors/moderators were inconclusive or lacked data. Our review highlights that it is currently difficult to predict, across diagnoses, who will benefit from guided IBIs. Further rigorous research is needed to identify predictors and moderators based on a sufficient number of studies. PROSPERO registration: CRD42021242305.
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Affiliation(s)
- Katrin Haller
- Clinical Psychological Interventions, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Pauline Becker
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Helen Niemeyer
- Clinical Psychological Interventions, Freie Universität Berlin, Berlin, Germany
| | - Johanna Boettcher
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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Gentili C, Zetterqvist V, Rickardsson J, Holmström L, Ljótsson B, Wicksell R. Examining predictors of treatment effect in digital Acceptance and Commitment Therapy for chronic pain. Cogn Behav Ther 2023:1-17. [DOI: 10.1080/16506073.2023.2191826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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12
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The Efficacy of Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:147-157. [PMID: 36827194 DOI: 10.1097/ajp.0000000000001096] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/03/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Previous meta-analyses of a small number of trials showed that acceptance and commitment therapy (ACT) might improve chronic pain. Many new trials have been published afterward, and the factors that may impact the efficacy of ACT are less understood. We, therefore, conducted an updated systematic review with meta-analysis to investigate the efficacy of ACT for people with chronic pain. METHODS Randomized controlled trials that investigated the efficacy of ACT in clinical or community setting for adult populations with chronic pain were included. The methodological quality of trials was assessed with the Cochrane Risk of Bias tool. Standardized mean differences between ACT and comparison groups in their effects on 6 outcomes (ie, pain acceptance, quality of life, pain-related functioning, pain intensity, anxiety, and depression) were pooled across studies. RESULTS Of the 3171 records identified, 21 trials with 1962 participants were included for analysis. The comparison groups included active treatment and waitlist control/usual care. The standardized mean difference was 0.67 (95% CI: 0.48, 0.87) for pain acceptance, 0.43 (95% CI: 0.29, 0.57) for quality of life, -0.88 (95% CI: -1.14, -0.63) for pain-related functioning, -0.45 (95% CI: -0.62, -0.27) for pain intensity, -0.35 (95% CI: -0.54, -0.15) for anxiety, and -0.74 (95% CI, -0.98, -0.50) for depression, all favoring ACT. Subgroup analyses showed that the effects were statistically significant across almost all subgroups and for some outcomes were greater in the trials conducted in people with a specific diagnosis (as compared with those conducted in people with general chronic pain), the trials with waitlist or usual care control, the trials with a greater number of sessions of ACT, and the trials with a longer ACT intervention. DISCUSSION ACT is effective and comparable to, if not better than, some other available active treatments for chronic pain.
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Bricker JB, Mull KE, Sullivan BM, Forman EM, Lillis J, McTiernan A, Santiago-Torres M. Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial. Contemp Clin Trials 2023; 126:107091. [PMID: 36682490 PMCID: PMC9998365 DOI: 10.1016/j.cct.2023.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Evan M Forman
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; College of Psychology, California Northstate University, Elk Grove, CA, USA
| | - Anne McTiernan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington School of Public Health, Department of Epidemiology, USA; University of Washington School of Medicine, Department of Medicine, USA
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Champion J, Crawford M, Jaaniste T. Predicting the Need for Transition from Pediatric to Adult Pain Services: A Retrospective, Longitudinal Study Using the Electronic Persistent Pain Outcome Collaboration (ePPOC) Databases. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020357. [PMID: 36832486 PMCID: PMC9955863 DOI: 10.3390/children10020357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
A proportion of youth with chronic pain do not respond to interdisciplinary pain management and may require transition to adult pain services. This study sought to characterize a cohort of patients referred to pediatric pain services who subsequently required referral to an adult pain service. We compared this transition group with pediatric patients eligible by age to transition but who did not transition to adult services. We sought to identify factors predicting the need to transition to adult pain services. This retrospective study utilized linkage data from the adult electronic Persistent Pain Outcomes Collaboration (ePPOC) and the pediatric (PaedePPOC) data repositories. The transition group experienced significantly higher pain intensity and disability, lower quality of life, and higher health care utilization relative to the comparison group. Parents of the transition group reported greater distress, catastrophizing, and helplessness relative to parents in the comparison group. Three factors significantly predicted transition: compensation status (OR = 4.21 (1.185-15)), daily anti-inflammatory medication use (OR = 2 (1.028-3.9)), and older age at referral (OR = 1.6 (1.3-2.17)). This study demonstrated that patients referred to pediatric pain services who subsequently need transition to adult services are a uniquely disabled and vulnerable group beyond comparative peers. Clinical applications for transition-specific care are discussed.
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Affiliation(s)
- Joel Champion
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Correspondence: (J.C.); (T.J.); Tel.: +61-2-93825423 (J.C.); +61-2-93825422 (T.J.)
| | - Matthew Crawford
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Tiina Jaaniste
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
- Correspondence: (J.C.); (T.J.); Tel.: +61-2-93825423 (J.C.); +61-2-93825422 (T.J.)
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15
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Chen JA, Anderson ML, Cherkin DC, Balderson BH, Cook AJ, Sherman KJ, Turner JA. Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:282-303. [PMID: 36180008 PMCID: PMC9898119 DOI: 10.1016/j.jpain.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with CLBP (N = 297), we examined baseline characteristics that moderated treatment effects or were associated with improvement regardless of treatment. Outcomes included 8-week function (modified Roland Disability Questionnaire), pain bothersomeness (0-10 numerical rating scale), and depression (Patient Health Questionnaire-8). There were differences in the effects of CBT versus MBSR on pain based on participant gender (P = .03) and baseline depressive symptoms (P = .01), but the only statistically significant moderator after Bonferroni correction was the nonjudging dimension of mindfulness. Scores on this measure moderated the effects of CBT versus MBSR on both function (P = .001) and pain (P = .04). Pain control beliefs (P <.001) and lower anxiety (P < .001) predicted improvement regardless of treatment. Replication of these findings is needed to guide treatment decision-making for CLBP. TRIAL REGISTRATION: The trial and analysis plan were preregistered in ClinicalTrials.gov (Identifier: NCT01467843). PERSPECTIVE: Although few potential moderators and nonspecific predictors of benefits from CBT or MBSR for CLBP were statistically significant after adjustment for multiple comparisons, these findings suggest potentially fruitful directions for confirmatory research while providing reassurance that patients could reasonably expect to benefit from either treatment.
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Affiliation(s)
- Jessica A Chen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Daniel C Cherkin
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
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16
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Prevalence of pain and its treatment among older adults in India: a nationally representative population-based study. Pain 2023; 164:336-348. [PMID: 36638306 DOI: 10.1097/j.pain.0000000000002705] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/25/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT There were no estimates of the prevalence of pain and its treatment in the older population of India obtained from face-to-face interviews with a nationally representative sample. We addressed this evidence gap by using data on 63,931 individuals aged 45 years and older from the 2017/2018 Longitudinal Ageing Study in India. We identified pain from an affirmative response to the question: Are you often troubled by pain? We also identified those who reported pain that limited usual activities and who received treatment for pain. We estimated age- and sex-adjusted prevalence of pain, pain limiting usual activity and treatment, and compared these estimates across states and sociodemographic groups. We used a multivariable probit model to estimate full adjusted differences in the probability of each outcome across states and sociodemographic groups. We estimated that 36.6% (95% confidence interval [CI]: 35.3-37.8) of older adults in India were often troubled by pain and 25.2% (95% CI: 24.2-26.1) experienced pain limiting usual activity. We estimated that 73.3% (95% CI: 71.9-74.6) of those often troubled by pain and 76.4% (95% CI: 74.9-78.0) of those with pain that limited usual activity received treatment. There was large variation in each outcome across states. Fully adjusted prevalence of pain and pain limiting usual activity were higher among individuals who were female, older, less educated, rural residents, and poorer. Prevalence of treatment among those troubled by pain was lower among socially disadvantaged groups.
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Ecija C, Catala P, Velasco L, Pastor-Mira MA, Peñacoba C. When It Hurts, a Positive Attitude May Help. The Moderating Effect of Positive Affect on the Relationship Between Walking, Depression, and Symptoms in Women with Fibromyalgia. Pain Manag Nurs 2022; 23:767-775. [PMID: 35840530 DOI: 10.1016/j.pmn.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/17/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased exercise is a marker of health in fibromyalgia (FM). However, patients frequently avoid physical activity as a way of minimizing the pain they feel. This deprives them of opportunities to obtain positive reinforcement, increasing functional impact. AIMS This study examines the mediating role of depressive symptoms between walking (as physical exercise), functional impact, and pain, at different levels of positive affect (PA) among women with fibromyalgia. DESIGN Cross-sectional correlational study. SETTINGS Mutual aid associations for fibromyalgia in Spain. PARTICIPANTS 231 women diagnosed with FM. METHODS Moderate mediation analyses were conducted using PROCESS. RESULTS First, a simple mediation model showed that depression mediated the effect of walking on functional impact, but not on pain. Additionally, the moderated mediated model showed that this effect was significant at medium and high levels of PA, but not when levels of PA were low. CONCLUSIONS Provision of resources focused on positive affect seem to increase the positive effects of walking on functional impact through the reduction of depressive symptoms. Nurses can improve adherence of patients with FM to walking behavior through increasing positive affect.
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Affiliation(s)
- Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lilian Velasco
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Mª Angeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
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18
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Margerison SM, Westlake KP, Seminowicz DA. Beyond pain in the brain: A clinician's guide to interpreting the spinal cord's role in the pain experience. Musculoskelet Sci Pract 2022; 62:102664. [PMID: 36116418 DOI: 10.1016/j.msksp.2022.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Physical therapy practice has greatly improved in providing a biopsychosocial approach when considering persistent pain. However, the spinal cord is often overlooked as a structure with an important role in modulating nociceptive information. PURPOSE This article highlights the role of the dorsal horn (DH) in nociceptive processing and its impact on persistent pain conditions as they appear clinically. Key processes occurring in the spinal cord are described, including cellular changes and local spinal network responses to nociceptive stimuli. Additionally, associated clinical symptoms are discussed and some aspects of physical therapy evaluation are challenged based on the mechanisms of nociceptive processing presented in this commentary. IMPLICATIONS The spinal cord is an active participant in nociceptive processing, directly impacting the intensity, spread, and recurrence of pain, including within the context of central sensitization. Changes in the behavior of DH neurons are possible with sufficient stimulation and may occur after injury. Additionally, spinal cord activation patterns may lead to bilateral symptoms given adequate strength and duration despite a single peripheral driver. Viewing the spinal cord as a dynamic structure capable of up or down regulating its response to stimuli gives the clinician a better understanding of the nervous system's complex response to prolonged nociceptive input.
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Affiliation(s)
- Sarah M Margerison
- Physical Therapy and Rehabilitation Science University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.
| | - Kelly P Westlake
- Physical Therapy and Rehabilitation Science University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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19
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Mowat RM, Lewis GN, Borotkanics RJ. What factors predict outcome from an inpatient multidisciplinary chronic pain service? A prospective cohort study. AUST HEALTH REV 2022; 46:686-694. [PMID: 36410721 DOI: 10.1071/ah22172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022]
Abstract
Objective To identify baseline factors associated with outcomes from an inpatient multidisciplinary pain management program (PMP) located in a bicultural area of Aotearoa New Zealand. Methods A prospective cohort study was undertaken involving 164 people with chronic pain who attended the PMP. Demographic, clinical, and psychosocial measures were obtained at baseline, whereas clinical and psychosocial outcome measures were also obtained at program discharge and 3-month follow up (N = 100). Multivariate analyses were used to determine baseline demographic variables that were associated with outcomes at discharge and follow up. Results Being male and working full-time were associated with poorer outcomes in select measures at discharge. At the 3-month follow up, Māori ethnicity, working full-time, being retired or unemployed, or having chronic widespread pain were associated with poorer outcomes for some measures, whereas those with rheumatoid arthritis had greater self-efficacy. Conclusions Sex, ethnicity, employment status, and patient condition impact clinical outcomes from the program and in the time from discharge to follow up. Program content and/or delivery should be altered to promote more equitable outcomes for all patients in the long term.
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Affiliation(s)
- Rebecca M Mowat
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Gwyn N Lewis
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Robert J Borotkanics
- Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand
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20
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Hennemann S, Böhme K, Kleinstäuber M, Ruckes C, Baumeister H, Daniel Ebert D, Küchler AM, Witthöft M. Is Therapist Support Needed? Comparing Therapist- and Self-Guided Internet-Based CBT for Somatic Symptom Distress (iSOMA) in Emerging Adults. Behav Ther 2022; 53:1205-1218. [PMID: 36229117 DOI: 10.1016/j.beth.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/01/2022] [Accepted: 06/18/2022] [Indexed: 11/19/2022]
Abstract
Persistent somatic symptoms of varying etiology are very common in emerging adults and can lead to distress and impairment. Internet-delivered interventions could help to prevent the burden and chronicity of persistent somatic symptoms. This study investigated the impact of therapist guidance on the effectiveness of a cognitive-behavioral Internet intervention for somatic symptom distress (iSOMA) in emerging adults, as a secondary analysis of a two-armed randomized controlled trial. We included 149 university students (83.2% female, 24.60 yrs) with varying degrees of somatic symptom distress who were either allocated to the 8-week intervention with regular, written therapeutic guidance (iSOMA guided) or to the control group (waitlist), which was afterwards crossed over to receive iSOMA with guidance-on-demand (iSOMA-GoD). Primary outcomes were somatic symptom distress (assessed by the PHQ-15) and psychobehavioral symptoms of the somatic symptom disorder (assessed by the SSD-12) at pre- and post-treatment. Secondary outcomes included depression, anxiety, and disability. Both treatments showed statistically significant pre-post improvements in primary (iSOMA-guided: d = 0.86-0.92, iSOMA-GoD: d = 0.55-0.63) and secondary outcomes. However, intention-to-treat analysis revealed non-significant between-group effects for all outcomes (ps ≥ .335), after controlling for confounding variables, and effect sizes were marginal (d = -0.06 to 0.12). Overall, our findings indicate that Internet-delivered cognitive behavioral therapy with regular guidance is not unequivocally superior to guidance-on-demand in alleviating somatic symptom distress and associated psychopathology in emerging adults. As a next step, non-inferiority studies are needed to test the robustness of these findings and their impact on clinical populations.
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Affiliation(s)
| | | | - Maria Kleinstäuber
- Utah State University, Emma Eccles Jones College of Education and Human Services
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials, University Medical Center of the Johannes Gutenberg University Mainz
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21
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Preliminary study: quantification of chronic pain from physiological data. Pain Rep 2022; 7:e1039. [PMID: 36213596 PMCID: PMC9534370 DOI: 10.1097/pr9.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Preliminary evidence suggests that physiological variables collected with our low-cost pain meter are correlated with chronic pain, both for individuals and populations. Introduction: It is unknown if physiological changes associated with chronic pain could be measured with inexpensive physiological sensors. Recently, acute pain and laboratory-induced pain have been quantified with physiological sensors. Objectives: To investigate the extent to which chronic pain can be quantified with physiological sensors. Methods: Data were collected from chronic pain sufferers who subjectively rated their pain on a 0 to 10 visual analogue scale, using our recently developed pain meter. Physiological variables, including pulse, temperature, and motion signals, were measured at head, neck, wrist, and finger with multiple sensors. To quantify pain, features were first extracted from 10-second windows. Linear models with recursive feature elimination were fit for each subject. A random forest regression model was used for pain score prediction for the population-level model. Results: Predictive performance was assessed using leave-one-recording-out cross-validation and nonparametric permutation testing. For individual-level models, 5 of 12 subjects yielded intraclass correlation coefficients between actual and predicted pain scores of 0.46 to 0.75. For the population-level model, the random forest method yielded an intraclass correlation coefficient of 0.58. Bland–Altman analysis shows that our model tends to overestimate the lower end of the pain scores and underestimate the higher end. Conclusion: This is the first demonstration that physiological data can be correlated with chronic pain, both for individuals and populations. Further research and more extensive data will be required to assess whether this approach could be used as a “chronic pain meter” to assess the level of chronic pain in patients.
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22
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Sarter L, Heider J, Witthöft M, Rief W, Kleinstäuber M. Using clinical patient characteristics to predict treatment outcome of cognitive behavior therapies for individuals with medically unexplained symptoms: A systematic review and meta-analysis. Gen Hosp Psychiatry 2022; 77:11-20. [PMID: 35390568 DOI: 10.1016/j.genhosppsych.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE For individuals with medically unexplained symptoms (MUS), cognitive behavioral therapy (CBT) is the best-evaluated treatment. This systematic review and meta-analyses identify clinical patient characteristics associated with the treatment outcome of CBT for MUS. METHODS A systematic literature search (PubMed, PsycInfo, Web of Science) resulted in 53 eligible studies; of these 32 studies could be included in meta-analyses. Pooled correlation coefficients between predictors and treatment outcome were calculated with a random-effects model. Moderator analyses were conducted to examine differences between subgroups of MUS and different levels of methodological study quality. RESULTS Meta-analyses demonstrated that individuals with higher symptom intensity (r = 0.38; p < 0.001), lower physical functioning (r = -0.29; p < 0.001), lower emotional and social functioning (r = -0.37; p < 0.001), more potential symptom-related incentives (r = -0.15; p = 0.001), or longer symptom duration (r = 0.10; p = 0.033) at the beginning of treatment reported less change of symptom severity until the end of therapy or higher end-of-treatment symptom severity. The pooled effect sizes did not differ between certain subgroups of MUS or between different levels of methodological quality. CONCLUSION Our findings indicated that clinical characteristics of MUS patients are associated with treatment outcome of CBT. We discuss how the results can be used to optimize and personalize future treatments for MUS.
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Affiliation(s)
- Lena Sarter
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35037 Marburg, Germany.
| | - Jens Heider
- University Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, 76829 Landau, Germany.
| | - Michael Witthöft
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany.
| | - Winfried Rief
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35037 Marburg, Germany.
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, USA.
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23
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Murillo C, Vo TT, Vansteelandt S, Harrison LE, Cagnie B, Coppieters I, Chys M, Timmers I, Meeus M. How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment. Clin Psychol Rev 2022; 94:102160. [PMID: 35561510 PMCID: PMC11146991 DOI: 10.1016/j.cpr.2022.102160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: -0.07; 95% confidence interval [CI]: -0.11, -0.04) and catastrophizing (IE: -0.07; 95%CI: -0.14, -0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: -0.11, -0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: -0.31, -0.03) and psychological flexibility (IE: -0.30; 95%CI: -0.41, -0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium
| | - Tat-Thang Vo
- Department of Statistics, The Wharton School, University of Pennsylvania, Pennsylvania, United States; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Iris Coppieters
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Marjolein Chys
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States; Department of Rehabilitation Medicine, Maastricht University, Netherlands
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Belgium.
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24
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Yu L, McCracken LM, Scott W. Predictors of Outcomes Following Interdisciplinary Acceptance and Commitment Therapy for Chronic Pain: Profiling Psychological Flexibility. Eur J Pain 2022; 26:1448-1459. [PMID: 35536177 PMCID: PMC9543918 DOI: 10.1002/ejp.1972] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/21/2022] [Accepted: 05/08/2022] [Indexed: 11/07/2022]
Abstract
Background Growing evidence demonstrates the benefit of acceptance and commitment therapy (ACT) for people with chronic pain. However, there remain people with chronic pain who do not benefit from ACT, and predicting treatment response is difficult. Aims This aim of this study was to investigate if baseline psychological flexibility (PF) profiles predict responses to an ACT‐based pain management programme. Methods Data from 415 participants attending an interdisciplinary pain management programme were included. Participants completed measures of PF processes and outcomes pre‐ and post‐treatment. Latent profile analysis was used to identify subgroups of participants based on their baseline PF scores. ANOVAs were conducted to compare subgroups of participants on outcome variables at baseline, and changes from pre‐ to post‐treatment. Results Three subgroups of participants were identified: (a) low PF, (b) low openness and (c) high awareness and action. The three subgroups significantly differed on all outcome measures at pre‐treatment, supporting the clinical relevance of these PF profiles. However, participants with different baseline PF profiles did not appear to differ in terms of changes in outcome variables. Conclusions People with chronic pain demonstrate different PF profiles, but appear to respond to ACT similarly regardless of these profiles. Future studies with a more individualized focus are needed to further understand which components of ACT work for whom on which outcome and how. Significance There remain people with chronic pain who do not benefit from acceptance and commitment therapy (ACT), and predicting treatment response is difficult. This is the first study to identify psychological flexibility (PF) profiles along multiple PF processes using latent class analysis, and the first longitudinal study to investigate PF profiles in relation to outcomes in ACT for chronic pain. The findings contribute to the understanding of theoretically consistent predictors of outcomes in ACT, which in turn can inform treatment development.
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Affiliation(s)
- Lin Yu
- Middlesex University, Department of Psychology, UK
| | | | - Whitney Scott
- INPUT Pain Management Unit, NHS Foundation Trust, Guy's and St Thomas, UK.,King's College London, Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, UK
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26
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Hennemann S, Witthöft M, Kleinstäuber M, Böhme K, Baumeister H, Ebert DD, Probst T. Somatosensory amplification moderates the efficacy of internet-delivered CBT for somatic symptom distress in emerging adults: Exploratory analysis of a randomized controlled trial. J Psychosom Res 2022; 155:110761. [PMID: 35182889 DOI: 10.1016/j.jpsychores.2022.110761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While studies mainly provide positive evidence for the efficacy of internet-delivered cognitive-behavioral therapy (ICBT) for various persistent somatic symptoms, it remains largely unclear for whom these interventions work or not. This exploratory analysis aimed to identify moderators for the outcome between ICBT for somatic symptom distres and a waitlist control group (WL) in a vulnerable target group of emerging adults. METHODS Based on data from a randomized controlled trial on 156 university students with varying degrees of somatic symptom distress who were allocated to either an eight-week, therapist guided ICBT (iSOMA) or to the WL, we examined pretreatment demographic characteristics, health-related variables (e.g., somatic symptom duration), mental distress (e.g., depression, anxiety) and cognitive-emotional factors (emotional reactivity, somatosensory amplification) as candidate moderators of the outcome, somatic symptom distress (assessed by the Patient Health Questionnaire, PHQ-15) from pre- to posttreatment. RESULTS Somatosensory amplification (assessed by the Somatosensory Amplification Scale, SSAS) moderated the outcome in favor of iSOMA (B = -0.17, SE = 0.08, p = 0.031), i.e., higher pretreatment somatosensory amplification was associated with better outcome in the active compared to the control intervention. No significant moderation effects were found among demographic characteristics, health-related variables, or mental distress. CONCLUSION Our findings suggest that an internet-delivered CBT for somatic symptom distress should be preferred over no active treatment particularly in individuals with moderate to high levels of somatosensory amplification, which as a next step should be tested against further treatments and in clinical populations. TRIAL REGISTRATION German Clinical Trials Register (DRKS00014375).
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Affiliation(s)
- Severin Hennemann
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Michael Witthöft
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Maria Kleinstäuber
- Utah State University, Emma Eccles Jones College of Education and Human Services, Department of Psychology, Logan (Utah), USA
| | - Katja Böhme
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Harald Baumeister
- Ulm University, Department of Clinical Psychology and Psychotherapy, Ulm, Germany
| | - David Daniel Ebert
- Technical University of Munich, Department of Sport and Health Sciences, München, Germany
| | - Thomas Probst
- Danube University Krems, Department for Psychotherapy and Biopsychosocial Health, Krems, Austria
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Abstract
Chronic pain conditions are common and have a considerable impact on health and wellbeing. This impact can be reduced by cognitive behavioral therapy (CBT), the most commonly applied psychological approach to chronic pain. At the same time, CBT continues to develop, and now includes what is sometimes called "third wave" CBT. In this review, we examine the evidence for application of acceptance and commitment therapy (ACT), a principal example of this new wave or latest generation of treatment approaches, in people with chronic pain. We identified 25 randomized controlled trials of ACT for adults with chronic pain. Across the included trials, small to large effect sizes favoring ACT were reported for key outcomes including pain interference, disability, depression, and quality of life. Evidence from three studies provided some support for the cost effectiveness of ACT for chronic pain. Evidence also supported the mediating role of theoretically consistent processes of change (psychological flexibility) in relation to treatment outcomes. Investigation of moderators and predictors of outcomes was limited and inconsistent. In future, a greater focus on process based treatments is recommended. This should include continued identification of evidence based processes of change, and research methods more suited to understanding the experience and needs of individual people.
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Affiliation(s)
| | - Lin Yu
- Department of Psychology, Middlesex University, London, UK
| | - Kevin E Vowles
- School of Psychology, Queens University Belfast, Belfast, UK
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Gilpin H, Ratanachatchuchai S, Novelli D, McCracken L, Scott W. Examining the association between group context effects and individual outcomes in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy. Br J Pain 2022; 16:420-432. [PMID: 36032341 PMCID: PMC9411762 DOI: 10.1177/20494637211073012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Although cognitive-behavioural treatments for chronic pain are delivered in groups, there is little research investigating group effects in these treatments. Purpose: The aim of this study was to investigate associations between group composition variables at the start of treatment and individual outcomes following intensive interdisciplinary treatment for pain based on Acceptance and Commitment Therapy. Methods: This was a secondary analysis of routinely collected observational data. Five-hundred and sixteen patients completed a standard set of demographic, pain-related, and psychosocial measures at pre- and post-treatment. Intracluster correlations (ICCs) were computed to examine the clustering of outcomes within groups and multilevel models explored the association between group composition variables and individual level outcomes. Results: The ICCs for pain intensity (0.11) and interference (0.09) suggested that multilevel models were warranted for these outcomes, while a multilevel model for post-treatment depression (ICC=0.04) was not warranted. Group percentage of participants receiving disability 8 benefits and group mean pain intensity at pre-treatment were significantly positively associated with individual level pain intensity at post-treatment, controlling for pre-treatment individual level pain intensity. Group mean pain intensity at pre-treatment was the only group variable that significantly predicted post-treatment pain interference at the individual level. Psychosocial group composition variables were not significantly associated with individual level outcomes. Conclusions: Given the limited predictive utility of group composition variables in the current study, future research should undertake direct assessment of group level therapeutic and counter-therapeutic processes to advance understanding of who benefits from group treatments for pain and how. As the variance in outcomes accounted for by group clustering was relatively small and significant within groups variance remained, research is also needed to further understand individual level factors that influence cognitive-behavioural treatment outcomes for pain.
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Affiliation(s)
| | | | | | | | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and NeuroscienceKing's College London
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Ding D, Zheng M. Associations Between Six Core Processes of Psychological Flexibility and Functioning for Chronic Pain Patients: A Three-Level Meta-Analysis. Front Psychiatry 2022; 13:893150. [PMID: 35898622 PMCID: PMC9309299 DOI: 10.3389/fpsyt.2022.893150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.
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Affiliation(s)
- Dongyan Ding
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Mengna Zheng
- School of Educational Science, Anhui Normal University, Wuhu, China
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Rosen NO, Vaillancourt-Morel MP, Corsini-Munt S, Steben M, Delisle I, Baxter ML, Bergeron S. Predictors and Moderators of Provoked Vestibulodynia Treatment Outcome Following a Randomized Trial Comparing Cognitive-Behavioral Couple Therapy to Overnight Lidocaine. Behav Ther 2021; 52:1502-1515. [PMID: 34656202 DOI: 10.1016/j.beth.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Provoked vestibulodynia is a vulvar pain condition causing sexual dysfunction, affecting 8% to 10% of women. Our recently published randomized clinical trial (N = 108 couples) found that cognitive behavioral couple therapy (CBCT) and topical lidocaine reduced women's pain and associated sexual symptoms, with CBCT showing more benefits. Little is known about pretreatment predictors of treatment outcomes in couples sex therapy. In the current study, we examined women and their partners' pretreatment demographic (age, relationship length), clinical (pain duration, anxiety) and interpersonal (partner responses to pain, sexual goals) predictors/moderators of women's pain intensity, pain unpleasantness, and sexual function at posttreatment and 6-month follow-up. Longer relationship duration, lower anxiety in women, partner higher solicitousness and partner higher approach sexual goals predicted better pain outcomes for women with PVD irrespective of treatment condition. CBCT was more effective than lidocaine for improving women's sexual function at posttreatment when, at pretreatment, women had partners with higher anxiety and women reported lower approach sexual goals, whereas lidocaine was more effective for improving women's sexual function at follow-up when partners had higher approach sexual goals. Findings can assist clinicians in determining what treatment will be most beneficial for whom.
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Senger K, Rubel JA, Kleinstäuber M, Schröder A, Köck K, Lambert MJ, Lutz W, Heider J. Symptom change trajectories in patients with persistent somatic symptoms and their association to long-term treatment outcome. Psychother Res 2021; 32:624-639. [PMID: 34711141 DOI: 10.1080/10503307.2021.1993376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study investigated symptom change trajectory for patients with persistent somatic symptoms (PSS) during psychotherapy and the association of these patterns with pre-treatment characteristics and long-term outcome. METHODS Growth mixture modeling was used to identify trajectory curves in a sample of N = 210 outpatients diagnosed with PSS and treated either with conventional cognitive behavioral therapy (CBT) or CBT enriched with emotion regulation training (ENCERT). RESULTS We identified three subgroups of patients with similar symptom change patterns over the course of treatment (a "no change," "strong response," and "slow change" subgroup). Higher initial anxiety symptoms were significantly associated with the no change and strong response subgroups; symptom-related disability in daily routine with no changes. Patients with a strong response had the highest proportion of reliable improvement at termination and at six-month-follow-up. CONCLUSION Our results indicate that, instead of one common change pattern, patients with PSS respond differently to treatment. Due to the high association of symptom curves with long-term outcome, the identification and prediction of an individual's trajectory could provide important information for clinicians to identify non-responding patients that are at risk for failure. Selecting personalized treatment interventions could increase the effectiveness of psychotherapy.Trial registration: ClinicalTrials.gov identifier: NCT01908855..
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Affiliation(s)
- Katharina Senger
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Julian A Rubel
- Department of Psychology, University of Giessen, Giessen, Germany
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Health Services, Utah State University, Logan, UT, USA
| | - Annette Schröder
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Katharina Köck
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Jens Heider
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
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Gasslander N, Alfonsson S, Jackalin A, Tengberg C, Håkansson J, Huotari L, Buhrman M. Predictors of adherence to an internet-based cognitive behavioral therapy program for individuals with chronic pain and comorbid psychological distress. BMC Psychol 2021; 9:156. [PMID: 34641946 PMCID: PMC8507117 DOI: 10.1186/s40359-021-00663-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The burden caused by chronic pain is significant, affecting at least 10 percent of the world´s population. While internet-based treatments based on cognitive behavioral therapy (CBT) have been shown to be promising in this area, attrition levels vary significantly. The purpose of this study was to investigate predictor variables for participants' adherence to an internet-based CBT treatment for individuals with chronic pain as well as to investigate associations between adherence and treatment outcome. METHODS Data for this study was retrieved from a randomized controlled trial including 95 individuals with chronic pain who received internet-based CBT. Treatment adherence was studied through three outcome variables: treatment progress, treatment completion and exercise completion. The predictor variables were grouped into four clusters: background variables (age, gender, marital status, level of education, and typical computer usage); the second cluster included health status variables (sick leave, current psychiatric diagnosis, previous psychotherapy for pain, current pharmacological treatment, previous depression, current depression, and current depressive symptoms); the third cluster included pain-related variables (opioid medication, history of pain, and pain symptoms) and the fourth cluster included motivation variables (measured with treatment preference, treatment credibility, compliance to the treatment schedule and contact with the therapists). RESULTS Findings showed that treatment progress was predicted by higher treatment credibility at baseline, whereas participants who were behind schedule in the second week of the program finished fewer treatment modules. When analyzing each cluster of predictor variables separately, current depressive symptoms also predicted fewer completed treatment modules. Among the pain-related variables, higher pain acceptance was the only predictor for completing more treatment modules. Treatment completion (which in this study was defined as having completed at least 75% of treatment modules) was predicted by higher treatment credibility and fewer depressive symptoms at baseline, and was thus similar to the results regarding treatment progress. Finally, all adherence variables predicted the treatment outcome pain interference. CONCLUSIONS Low treatment credibility, depressive symptoms and falling behind the treatment schedule early on were the most important predictor variables for low treatment adherence, while a number of demographical and pain-related variables were not related to adherence. The results from this study may help clinicians identify patients who are less likely to complete, and thus benefit from, their pain treatment. Trial registration ClinicalTrials.gov NTC03316846.
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Affiliation(s)
- Nils Gasslander
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden.
| | - Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Amanda Jackalin
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Cecilia Tengberg
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Johanna Håkansson
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Linda Huotari
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
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McCracken LM. Cognitive behavioral therapy, process-based approaches, and evolution in the context of physical health. World Psychiatry 2021; 20:383-385. [PMID: 34505357 PMCID: PMC8429312 DOI: 10.1002/wps.20891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Donahue ML, Dunne EM, Gathright EC, DeCosta J, Balletto BL, Jamison RN, Carey MP, Scott-Sheldon LAJ. Complementary and integrative health approaches to manage chronic pain in U.S. military populations: Results from a systematic review and meta-analysis, 1985-2019. Psychol Serv 2021; 18:295-309. [PMID: 32134305 PMCID: PMC7483193 DOI: 10.1037/ser0000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The objective of this study was to examine the efficacy of complementary and integrative health (CIH) approaches for reducing pain intensity (primary outcome) and depressive symptoms (secondary outcome) as well as improving physical functioning (secondary outcome) among U.S. military personnel living with chronic pain. Studies were retrieved from bibliographic databases, databases of funded research, and reference sections of relevant articles. Studies that (a) evaluated a CIH approach to promote chronic pain management among military personnel, (b) used a randomized controlled trial design, and (c) assessed pain intensity were included. Two coders extracted data from each study and calculated effect sizes. Discrepancies between coders were resolved through discussion. Comprehensive searches identified 12 studies (k = 15 interventions) that met inclusion criteria. CIH practices included cognitive-behavioral therapies (k = 5), positive psychology (k = 3), yoga (k = 2), acupuncture (k = 2), mindfulness-based interventions (k = 2), and biofeedback (k = 1). Across these studies, participants who received the intervention reported greater reductions in pain intensity (d+ = 0.44, 95% CI [0.21, 0.67], k = 15) compared to controls. Statistically significant improvements were also observed for physical functioning (d+ = 0.36, 95% CI [0.11, 0.61], k = 11) but not for depressive symptoms (d+ = 0.21, 95% CI [-0.15, 0.57], k = 8). CIH approaches reduced pain intensity and improved physical functioning. These approaches offer a nonpharmacological, nonsurgical intervention for chronic pain management for military personnel. Future studies should optimize interventions to improve depressive symptoms in military populations experiencing chronic pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Marissa L. Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Eugene M. Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI
| | - Emily C. Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI
| | - Julie DeCosta
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Brittany L. Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Robert N. Jamison
- Pain Management Center, Brigham and Women’s Hospital, Chestnut Hill, MA
- Harvard Medical School, Boston, MA
| | - Michael P. Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Lori A. J. Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
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Åkerblom S, Cervin M, Perrin S, Rivano Fischer M, Gerdle B, McCracken LM. A Network Analysis of Clinical Variables in Chronic Pain: A Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). PAIN MEDICINE 2021; 22:1591-1602. [PMID: 33706371 DOI: 10.1093/pm/pnaa473] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective. METHODS In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. RESULTS We found that Acceptance, Pain Interference, and Depression were key, "central," variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders. CONCLUSIONS This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.
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Affiliation(s)
- Sophia Åkerblom
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.,Department of Psychology, Lund University, Lund, Sweden
| | - Matti Cervin
- Faculty of Medicine, 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
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
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Vallejo MA, Vallejo-Slocker L, Offenbaecher M, Hirsch JK, Toussaint LL, Kohls N, Sirois F, Rivera J. Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7300. [PMID: 34299758 PMCID: PMC8307804 DOI: 10.3390/ijerph18147300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/27/2022]
Abstract
Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.
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Affiliation(s)
- Miguel A. Vallejo
- Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Laura Vallejo-Slocker
- Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Martin Offenbaecher
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Jameson K. Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA;
| | | | - Niko Kohls
- Division of Integrative Health Promotion, University of Applied Science and Arts, 96450 Coburg, Germany;
| | - Fuschia Sirois
- Department of Psychology, University of Sheffield, Sheffield S1 2LT, UK;
| | - Javier Rivera
- Rehumatology Unit, Instituto Provincial de Rehabilitación, Hospital General Universitario “Gregorio Marañón”, 28028 Madrid, Spain;
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Brooks T, Sharp R, Evans S, Baranoff J, Esterman A. Psychological Interventions for Women with Persistent Pelvic Pain: A Survey of Mental Health Clinicians. J Multidiscip Healthc 2021; 14:1725-1740. [PMID: 34262286 PMCID: PMC8275108 DOI: 10.2147/jmdh.s313109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To establish which psychological therapies mental health professionals use with reference to the treatment of women with persistent pelvic pain conditions. This research investigates overall therapies and specific techniques that clinicians believe are the most effective with this patient group, and the challenges mental health clinicians face in administering interventions. The study aims to suggest improvements to clinical practice and establish directions for targeted future research. Design Cross-sectional survey design. Methods An online survey was developed to ask mental health clinicians questions regarding the therapies and techniques they use with women experiencing persistent pelvic pain, their perspective on their practice in this area. The survey was advertised on relevant social media and professional websites. Survey results were tabled, and chi-square statistical analyses were undertaken to examine differences in therapy use according to country and profession. Results Mental health clinicians predominantly utilized cognitive behavioral therapy, acceptance and commitment therapy and associated techniques for women with persistent pelvic pain conditions. The results of the chi-square analyses showed that psychologists were more likely to use cognitive behavioral therapy or acceptance and commitment therapy, than counsellors who preferred counselling interventions. Chi-square analyses showed that Australian clinicians used acceptance and commitment therapy with a higher frequency than mental health clinicians in other countries. Clinicians provided multiple insights into their experiences working with women affected by persistent pelvic pain and their opinions as to valuable future research directions. Conclusion Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness therapies were most commonly used by mental health clinicians working with women with persistent pelvic pain conditions, despite severely limited evidence for the use of these psychological interventions in this client group.
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Affiliation(s)
- Tiffany Brooks
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Rebecca Sharp
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Susan Evans
- Welland Health, North Adelaide, South Australia, Australia
| | - John Baranoff
- Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
| | - Adrian Esterman
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
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Lewis GN, Bean DJ. What Influences Outcomes From Inpatient Multidisciplinary Pain Management Programs?: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:504-523. [PMID: 33883414 DOI: 10.1097/ajp.0000000000000941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although inpatient multidisciplinary pain management programs (PMPs) are effective for chronic pain, not all patients benefit equally and there is limited evidence regarding predictors of outcome. This meta-analysis aimed to identify patient or program characteristics associated with outcomes from inpatient PMPs, and to examine the time course of effects following discharge. MATERIALS AND METHODS Medline, EBSCO, and Scopus were searched to identify articles reporting outcomes from inpatient multidisciplinary PMPs. Information was extracted on study design, participant and program characteristics, and outcomes. Effect sizes were computed for pain, physical function, depression, anxiety, and mental health outcomes. Study-level predictors of outcome were investigated with moderator analyses and meta-regression. A risk of bias assessment and sensitivity analyses were conducted and the GRADE criteria for prognostic studies were applied to assess confidence in findings. RESULTS In all, 85 studies (111 cohorts; 15,255 participants) were included. Three quarters of studies demonstrated low risk of bias. Larger effect sizes (for at least 1 outcome measure) occurred in studies where participants had more severe pain (greater intensity/longer duration), participants with alcohol or drug problems were not excluded, samples comprised mixed pain conditions, and programs included a cognitive component and/or a passive therapy component. Effect sizes for pain and physical function were maintained at follow-up, but effect sizes for depression and anxiety declined over time. DISCUSSION Inpatient multidisciplinary PMPs may be well suited to patients with severe or long-lasting pain. Programs should adopt broad patient inclusion criteria, and outcomes were similar for programs based on cognitive-behavioral versus mindfulness/acceptance-based therapies.
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Affiliation(s)
- Gwyn N Lewis
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
| | - Debbie J Bean
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
- Chronic Pain Service, Department of Anaesthesiology & Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
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Sarter L, Heider J, Kirchner L, Schenkel S, Witthöft M, Rief W, Kleinstäuber M. Cognitive and emotional variables predicting treatment outcome of cognitive behavior therapies for patients with medically unexplained symptoms: A meta-analysis. J Psychosom Res 2021; 146:110486. [PMID: 33879330 DOI: 10.1016/j.jpsychores.2021.110486] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS). We still need a better understanding of what characterizes patients with MUS who benefit more or less from CBT. This systematic review aimed to identify patients' cognitive-emotional characteristics predicting the outcome of CBT for MUS. METHODS A systematic literature search (PubMed, PsycINFO, Web of Science) revealed 37 eligible studies, 23 of these provided data for meta-analyses. Mean correlation coefficients between predictor variables and the outcomes (symptom intensity, physical or social-emotional functioning) were calculated using a random-effects model. Differences between syndromes of MUS were investigated with moderator analyses. RESULTS Meta-analyses showed that patients with a comorbid mood disorder (r = 0.32, p < .01) or anxiety disorder (r = 0.18, p < .01), symptom catastrophizing and worries (r = 0.34, p < .01), tendencies of somatosensory amplification (r = 0.46, p = .04), and low symptom acceptance or self-efficacy (r = 0.25, p < .01) have a less favorable CBT outcome. Moderator analyses revealed that these associations between predictors and treatment outcome are pronounced in patients with chronic fatigue syndrome and irritable bowel syndrome. CONCLUSIONS Our results show that pre-treatment differences in patients' cognitive-emotional characteristics predict patients' outcome in CBT. Patient-tailored CBT could be a promising approach to address MUS patients' widely varying needs more effectively. PROTOCOL REGISTRATION The protocol of this systematic review and meta-analysis was registered in the PROSPERO registry (CRD 42018098649).
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Affiliation(s)
- Lena Sarter
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
| | - Jens Heider
- University Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Landau, Germany.
| | - Lukas Kirchner
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
| | - Sandra Schenkel
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Michael Witthöft
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Winfried Rief
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
| | - Maria Kleinstäuber
- University of Otago, Otago Medical School - Dunedin Campus, Department of Psychological Medicine, Dunedin, New Zealand.
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Predictors and moderators of outcomes in mindfulness-based cognitive therapy intervention for early breast cancer patients. Palliat Support Care 2021; 20:159-166. [PMID: 34158140 DOI: 10.1017/s147895152100078x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To deliver mindfulness-based cognitive therapy (MBCT) efficiently, the present study aimed (1) to identify predictors and moderators of patients who benefit from MBCT for psychological distress and (2) to explore the initial treatment reaction to identify the optimal number of sessions that produce a significant clinical effect. METHODS This is the secondary analysis of a randomized controlled trial of MBCT for breast cancer patients (N = 74). We classified the participants into remitters vs. non-remitters, and responder vs. non-responders, according to the total score of the Hospital Anxiety and Depression Scale at the end of the intervention. We conducted multivariate analyses to explore for predictors of response and remission. We adopted generalized estimating equations to explore the optimal number of sessions. RESULTS Sociodemographic and clinical backgrounds did not have significant influence on the treatment outcomes of the MBCT. Better program adherence, which was represented as the participants' better attendance to the MBCT program, was a significant predictor of both remission and response [odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.25-2.89, p = 0.003, and OR = 1.72, 95% CI 1.12-2.65, p = 0.013, respectively]. It was not until seventh session that the remission rate exceeded 50% and the response rate showed significance. SIGNIFICANCE OF RESULTS Sociodemographic and clinical characteristics did not significantly influence the treatment outcomes, while homework minutes and class attendance had significant effects on treatment outcomes. This implies that MBCT is recommended to any cancer patient, if he/she is motivated to the program, regardless of their sociodemographic and clinical characteristics. Patients are encouraged to attend a standard MBCT program (eight sessions) and do the assigned homework as intensely as possible. Further studies with larger sample and objective measurements are desired.
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Senger K, Schröder A, Kleinstäuber M, Rubel JA, Rief W, Heider J. Predicting optimal treatment outcomes using the Personalized Advantage Index for patients with persistent somatic symptoms. Psychother Res 2021; 32:165-178. [PMID: 33910487 DOI: 10.1080/10503307.2021.1916120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Because individual patients with persistent somatic symptoms (PSS) respond differently to treatments, a better understanding of the factors that predict therapy outcomes are of high importance. Aggregating a wide selection of information into the treatment-decision process is a challenge for clinicians. Using the Personalized Advantage Index (PAI) this study aims to deal with this. Methods: Data from a multicentre RCT comparing CBT (N = 128) versus CBT enriched with emotion regulation training (ENCERT) (N = 126) for patients diagnosed with somatic symptom disorder were used to identify based on two machine learning approaches predictors of therapy outcomes. The identified predictors were used to calculate the PAI. Results: Five treatment unspecific predictors (pre-treatment somatic symptom severity, depression, symptom disability, health-related quality of life, age) and five treatment specific moderators (global functioning, early childhood traumatic events, gender, health anxiety, emotion regulation skills) were identified. Individuals assigned to their PAI-indicated optimal treatment had significantly lower somatic symptom severity at the end of therapy compared to those randomised to their non-optimal condition. Conclusion: Allowing patients to choose a personalised treatment seems to be meaningful. This could help to improve outcomes for PSS and reduce its high costs to the health care system.
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Affiliation(s)
- Katharina Senger
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Annette Schröder
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Julian A Rubel
- Department of Psychology, University of Giessen, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Germany
| | - Jens Heider
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
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de Zoete A, de Boer MR, Rubinstein SM, van Tulder MW, Underwood M, Hayden JA, Buffart LM, Ostelo R. Moderators of the Effect of Spinal Manipulative Therapy on Pain Relief and Function in Patients with Chronic Low Back Pain: An Individual Participant Data Meta-analysis. Spine (Phila Pa 1976) 2021; 46:E505-E517. [PMID: 33186277 PMCID: PMC7993913 DOI: 10.1097/brs.0000000000003814] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/28/2020] [Accepted: 09/17/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Individual participant data (IPD) meta-analysis. OBJECTIVE The aim of this study was to identify which participant characteristics moderate the effect of spinal manipulative therapy (SMT) on pain and functioning in chronic LBP. SUMMARY OF BACKGROUND The effects of SMT are comparable to other interventions recommended in guidelines for chronic low back pain (LBP); however, it is unclear which patients are more likely to benefit from SMT compared to other therapies. METHODS IPD were requested from randomized controlled trials (RCTs) examining the effect of SMT in adults with chronic LBP for pain and function compared to various other therapies (stratified by comparison). Potential patient moderators (n = 23) were a priori based on their clinical relevance. We investigated each moderator using a one-stage approach with IPD and investigated this interaction with the intervention for each time point (1, 3, 6, and 12 months). RESULTS We received IPD from 21 of 46 RCTs (n = 4223). The majority (12 RCTs, n = 2249) compared SMT to recommended interventions. The duration of LBP, baseline pain (confirmatory), smoking, and previous exposure to SMT (exploratory) had a small moderating effect across outcomes and follow-up points; these estimates did not represent minimally relevant differences in effects; for example, patients with <1 year of LBP demonstrated more positive point estimates for SMT versus recommended therapy for the outcome pain (mean differences ranged from 4.97 (95% confidence interval, CI: -3.20 to 13.13) at 3 months, 10.76 (95% CI: 1.06 to 20.47) at 6 months to 5.26 (95% CI: -2.92 to 13.44) at 12 months in patients with over a year LBP. No other moderators demonstrated a consistent pattern across time and outcomes. Few moderator analyses were conducted for the other comparisons because of too few data. CONCLUSION We did not identify any moderators that enable clinicians to identify which patients are likely to benefit more from SMT compared to other treatments.Level of Evidence: 2.
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Affiliation(s)
- Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Michiel R. de Boer
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sidney M. Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maurits W. van Tulder
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science research institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Jill A. Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laurien M. Buffart
- Radboud UMC, Nijmegen, the Netherlands
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science research institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
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Balter LJT, Wiwe Lipsker C, Wicksell RK, Lekander M. Neuropsychiatric Symptoms in Pediatric Chronic Pain and Outcome of Acceptance and Commitment Therapy. Front Psychol 2021; 12:576943. [PMID: 33897515 PMCID: PMC8062759 DOI: 10.3389/fpsyg.2021.576943] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/25/2021] [Indexed: 12/29/2022] Open
Abstract
Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy (ACT) treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 years (N = 47) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities (i.e., pain interference, sleep, and physical and school functioning), socioemotional functioning (i.e., depressive symptoms, emotional, and social functioning), psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key.
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Affiliation(s)
- Leonie J T Balter
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Camilla Wiwe Lipsker
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Functional Area Medical Psychology, Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rikard K Wicksell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Functional Area Medical Psychology, Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lekander
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Behavioral Test (BAT-Back): Preliminary Evidence for a Successful Predictor of Treatment Outcome After Exposure Treatment for Chronic Low Back Pain. Clin J Pain 2021; 37:265-269. [PMID: 33555697 DOI: 10.1097/ajp.0000000000000920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although several questionnaires assessing fear of movement exist, it is still a challenge to identify individuals who might benefit more from exposure for chronic pain than from other psychological approaches and vice versa. Psychological approaches to chronic pain cannot advance toward the often called-for "tailored approaches" because of limited knowledge about treatment predictors. Our aim was to evaluate the additional predictive value of avoidance behavior based on behavioral observation. METHODS This study examined pretreatment self-report and behavioral measures as predictors of treatment outcome for n=43 patients experiencing disabling chronic low back pain, who took part in a randomized controlled trial in which they received 10 to 15 sessions of exposure treatment. Only patients with elevated fear avoidance based on self-report measures were included. Data were analyzed using regression analyses and classification and regression trees. RESULTS Regression analyses showed that higher avoidance behavior at pretreatment as measured by the Behavioral Avoidance Test-Back Pain (BAT-Back) significantly predicted reduction in global disability (with a small to medium effect), but not in specific disability. Self-report measures failed to predict treatment success for both outcome measures. Classification and regression trees divide subgroups who might benefit from exposure treatment through a BAT-Back score of >22 for Pain Disability Index. DISCUSSION There is some preliminary evidence that pretreatment avoidance behavior might be an indicator for reduction in global disability after exposure treatments in patients experiencing disabling chronic low back pain and elevated fear avoidance. We identified preliminary cutoff scores that need further investigation.
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Liu YM, Feng Y, Liu YQ, Lv Y, Xiong YC, Ma K, Zhang XW, Liu JF, Jin Y, Bao HG, Yan M, Song T, Liu Q. Chinese Association for the Study of Pain: Expert consensus on chronic postsurgical pain. World J Clin Cases 2021; 9:2090-2099. [PMID: 33850928 PMCID: PMC8017506 DOI: 10.12998/wjcc.v9.i9.2090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/15/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic postsurgical pain is a common surgical complication that severely reduces a patient’s quality of life. Many perioperative interventions and management strategies have been developed for reducing and managing chronic postsurgical pain. Under the leadership of the Chinese Association for the Study of Pain, an editorial committee was formed for chronic postsurgical pain diagnosis and treatment by experts in relevant fields. The editorial committee composed the main content and framework of this consensus and established a working group. The working group conducted literature review (1989-2020) using key words such as “surgery”, “post-surgical”, “post-operative”, “pain”, “chronic”, and “persistent” in different databases including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. Only publications in the English language were included. The types of literature included systematic reviews, randomized controlled studies, cohort studies and case reports. This consensus was written based on clinical practice combined with literature evidence. The first draft of the consensus was rigorously reviewed and edited by all the editorial committee experts before being finalized. The level of evidence was assessed by methodological experts based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The strength of recommendation was evaluated by all editorial committee experts, and the opinions of most experts were adopted as the final decision. The recommendation level “strong” generally refers to recommendations based on high-level evidence and consistency between clinical behavior and expected results. The recommendation level “weak” generally refers to the uncertainty between clinical behavior and expected results based on low-level evidence.
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Affiliation(s)
- Yi-Ming Liu
- Department of Algology, Peking University People’s Hospital, Beijing 100044, China
| | - Yi Feng
- Department of Algology, Peking University People’s Hospital, Beijing 100044, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yan Lv
- Department of Algology, Air Force Medical University of PLA, Xi’an 710032, Shaanxi Province, China
| | - Yuan-Chang Xiong
- Department of Anesthesiology, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xian-Wei Zhang
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jin-Feng Liu
- Department of Algology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Yi Jin
- Department of Algology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou 310058, Zhejiang Province, China
| | - Tao Song
- Department of Algology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Qing Liu
- Department of Algology, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Laitner MH, Erickson LC, Ortman E. Understanding the Impact of Sex and Gender in Osteoarthritis: Assessing Research Gaps and Unmet Needs. J Womens Health (Larchmt) 2020; 30:634-641. [PMID: 33325792 DOI: 10.1089/jwh.2020.8828] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Osteoarthritis (OA) affects more than 300 million individuals globally, with higher prevalence in women than in men. In addition, OA affects women and men differently, with women demonstrating both increased disease severity and disability. The Society for Women's Health Research (SWHR) convened an interdisciplinary group of expert researchers and clinicians for a roundtable meeting to review the current state of the science on OA and to identify knowledge gaps in the scientific literature, especially as they relate to the topics of sex and gender. The current review summarizes discussions from the roundtable and prioritizes areas of need that warrant further attention in OA research, diagnosis, care, and education. Improvements in basic and clinical research, clinical practice, patient education, and policy are needed to allow for better understanding as to the pathogenesis of sex- and gender-related disparities in OA.
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Affiliation(s)
- Melissa H Laitner
- The Society for Women's Health Research, Washington, District of Columbia, USA
| | | | - Emily Ortman
- The Society for Women's Health Research, Washington, District of Columbia, USA
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Esteve R, López-Martínez AE, Ruíz-Párraga GT, Serrano-Ibáñez ER, Ramírez-Maestre C. Pain Acceptance and Pain-Related Disability Predict Healthcare Utilization and Medication Intake in Patients with Non-Specific Chronic Spinal Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155556. [PMID: 32752085 PMCID: PMC7432233 DOI: 10.3390/ijerph17155556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023]
Abstract
Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months’ duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability—understood as giving up normal activities—can lead to reductions in healthcare utilization and medication intake.
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Affiliation(s)
- Rosa Esteve
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Alicia Eva López-Martínez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Gema Teresa Ruíz-Párraga
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Elena Rocío Serrano-Ibáñez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Facultad de Ciencias de la Salud, Área de Psicología, Universidad Isabel I, 09003 Burgos, Spain
| | - Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Correspondence: ; Tel.: +34-952-132-389
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Åkerblom S, Perrin S, Rivano Fischer M, McCracken LM. Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: the contributions of psychological flexibility. J Behav Med 2020; 44:111-122. [PMID: 32642875 PMCID: PMC7846536 DOI: 10.1007/s10865-020-00168-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/19/2020] [Indexed: 11/26/2022]
Abstract
There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain outcomes. The first aim of this study was to assess whether pre-treatment scores on measures of psychological (in)flexibility, acceptance, committed action, cognitive (de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological flexibility measures, only pre-treatment scores on the psychological inflexibility scale predicted outcomes; higher scores on this measure were associated with worse outcomes. However, change scores on each of the psychological flexibility measures separately mediated outcomes. The efficacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychological flexibility.
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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
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Abstract
STUDY DESIGN Epidemiological study based on cross-sectional data of a representative sample. OBJECTIVE To determine whether financial worries are associated with chronic spinal pain in the US adult population. SUMMARY OF BACKGROUND DATA This study used data from the US 2015 National Health Interview Survey. The sample size was 33,672 and the study population is defined as aged 18 to 85 years. METHODS To account for the complex sampling design, the Taylor linearized variance estimation method was used. Spinal pain was defined in two ways: chronic low back pain and neck pain, chronic low back pain and/or neck pain. Eight types of financial worries were assessed: paying monthly bills, maintaining standard of living, credit card payments, paying rent/mortgage/housing costs, medical costs for healthcare, money for retirement, medical costs of illness/accident, and paying for children's college. RESULTS Different types of financial worries were significantly associated with chronic spinal pain, controlling for demographic characteristics and socioeconomic status. These worries included paying monthly bills (odds ratio [OR] 2.5), maintaining standard of living (OR 2.5), credit card payments (OR 2.2), paying rent/mortgage/housing costs (OR 2.2), medical costs for healthcare (OR 2.2), money for retirement, (OR 2.3), medical costs of illness/accident (OR 2.2), and paying for children's college (OR 1.4). CONCLUSION This study shows that financial worries were significantly associated with chronic spinal pain. Financial worries may be important to be taken into consideration by clinicians managing patients with spinal pain. More future research is needed to explore the association between financial worries and spinal pain. LEVEL OF EVIDENCE 3.
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Elomaa M, Hotta J, de C Williams AC, Forss N, Äyräpää A, Kalso E, Harno H. Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy. Scand J Pain 2020; 19:257-270. [PMID: 30789827 DOI: 10.1515/sjpain-2018-0098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/29/2018] [Indexed: 12/22/2022]
Abstract
Background and aims Complex Regional Pain Syndrome (CRPS) often recovers spontaneously within the first year, but when it becomes chronic, available rehabilitative therapies (pharmacological management, physiotherapy, and psychological intervention) have limited effectiveness. This study examined the effect of a 12-week intensive outpatient rehabilitation on pain relief and function in chronic CRPS patients. Rehabilitation program included memantine and morphine treatment (added to patient's prior pain medication) and concurrent psychological and physiotherapeutic intervention. Primary outcome measure was a change in CRPS symptom count and secondary outcomes were motor performance, psychological factors, pain intensity, and quality of life. Methods Ten patients with chronic upper limb CRPS I (median 2.9 years, range 8 months to 12 years) were recruited to the study and were assessed before and after the intervention. Hand motor function of the patients was evaluated by an independent physiotherapist. There were standardized questionnaires for depression, pain anxiety, pain acceptance, quality of life, and CRPS symptom count. In addition, psychological factors were evaluated by a semi-structured interview. Severity of experienced pain was rated at movement and at rest. In addition, a video experiment of a hand action observation was conducted pre- and post-intervention to study possible change in neuronal maladaptation. Intervention consisted of pharmacological, psychological and physiotherapeutic treatment. First, 10 mg daily morphine was started and increased gradually to 30 mg daily, if tolerated. After 30 mg/day or tolerated dose of morphine was achieved, 5 mg daily memantine was started and increased gradually to 40 mg, if tolerated. Psychological intervention consisted of weekly group sessions, using cognitive and behavioral methods (relaxation, behavioral activation, and exposure) and acceptance and commitment therapy (ACT) and daily home practice. Physiotherapeutic intervention consisted of graded motor imagery and physiotherapy exercises with weekly group sessions and/or individual guidance by the physiotherapist, and individual exercise of the affected upper limb. Results Multimodal intensive intervention resulted in significant decrease in CRPS symptom count. The effect was strongest in motor and trophic symptoms (19% decrease after intervention) and in sensory symptoms (18% decrease). Additionally, improvement was seen in some, but not all, secondary outcomes (movement pain, motor symptoms, change in perceptions during video experiment of hand actions, and summary index with motor functioning, pain, and psychological factors). There were no dropouts. Conclusions Intensive 12-week multimodal intervention reduced some CRPS symptoms but was not sufficient to alter patients' rest pain, distress, or quality of life. Implications These results support the efficacy of an interdisciplinary rehabilitation program for pain and function in chronic CRPS patients. After intervention, some CRPS symptoms reduced and function improved, but distress and quality of life were unchanged. This may be due to the relatively short duration of this program; to delayed effects; to particular cognitive problems of CPRS patients; and/or to low distress levels at baseline that make statistically significant reduction less likely.
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Affiliation(s)
- Minna Elomaa
- Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jaakko Hotta
- Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nina Forss
- Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Anni Äyräpää
- Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Internal Medicine and Rehabilitation, Physiotherapy, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eija Kalso
- Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanno Harno
- Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pain Clinic, Department of Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, P.O Box 140, 00029 HUS, Helsinki, Finland, Phone: +358504639469, Fax: +358947175641
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