1
|
Fallon L, Lau AY, Ciccia D, Duckworth TJ, Pereira C, Kopp E, Perica V, Sherman KA. Perceived challenges in treatment decision-making for endometriosis: healthcare professional perspectives. Health Psychol Behav Med 2024; 12:2383469. [PMID: 39100426 PMCID: PMC11295683 DOI: 10.1080/21642850.2024.2383469] [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: 03/12/2024] [Accepted: 07/13/2024] [Indexed: 08/06/2024] Open
Abstract
Background Endometriosis, a systemic chronic inflammatory condition which has no cure, has a high symptom burden that can negatively impact every facet of life. Given the absence of a gold-standard treatment, the best symptom management regimen in endometriosis is heavily reliant on a patient's values and preferences, making shared decision-making (SDM) vital. However, a comprehensive patient decision aid (PtDA) intervention that could facilitate patient decision-making and promote SDM is lacking in endometriosis, and there is little research on the decisional support needs of individuals with this condition. This qualitative study aimed to explore healthcare professional (HP) perspectives of their clients' decisional support needs when choosing treatments to manage endometriosis symptoms, with a view to evaluating the need for a PtDA. Methods Australian HPs identified as specialising in endometriosis care (N = 13) were invited to participate in a short interview over the Internet by phone. Questions focussed on perceived facilitators and challenges of decision-making when choosing treatments for endometriosis. Transcribed qualitative data were thematically analysed and verified by multiple coders, using the template approach. Results Four themes were identified: (1) Identifying and setting priorities; (2) HPs' lack of time and perceived lack of knowledge; (3) Patient-centred care and SDM, including patient capacity; and (4) Decision-making blinded by hope. This is the first known study to explore HPs' perspectives on patient decision-making challenges in endometriosis. Discussion Findings draw attention to the difficulties people with endometriosis experience when assessing and choosing treatments, highlighting the need for a comprehensive PtDA intervention to support this decision-making.
Collapse
Affiliation(s)
- Lynda Fallon
- School of Psychological Sciences, Macquarie University, Sydney, Australia
- Lifespan Health and Wellbeing Research Centre, Sydney, Australia
| | - Annie Y.S. Lau
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Donna Ciccia
- National Institute of Complementary Medicine (NICM), Health Research Institute, Western Sydney University, Sydney, Australia
- Endometriosis Australia, Sydney, Australia
| | - Tanya Jane Duckworth
- Endometriosis Australia, Sydney, Australia
- School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Chantelle Pereira
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Emily Kopp
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Valentina Perica
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Kerry A. Sherman
- School of Psychological Sciences, Macquarie University, Sydney, Australia
- Lifespan Health and Wellbeing Research Centre, Sydney, Australia
| |
Collapse
|
2
|
Jin J, Yarns BC. The Impact of Stressful Life Events on Centralized Pain and Pain Intensity: A Combined Model Examining the Mediating Roles of Anger and Perceived Injustice Among Racially Minoritized Adults With Chronic Pain. THE JOURNAL OF PAIN 2024:104642. [PMID: 39067581 DOI: 10.1016/j.jpain.2024.104642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
Stressful life events are highly associated with chronic pain. Yet, research is needed to identify the psychological mechanisms that link life adversity and pain, especially studies that test comprehensive models, recruit racially diverse samples, and measure varied pain-related symptoms. This study examined the relationship between stressful life events and pain in a racially diverse sample and tested the potential mediating roles of both anger and perceived injustice. Both centralized pain symptoms and pain intensity were the outcomes. Analyses consisted of 2 cross-sectional, mediation models among 673 adults with self-reported chronic pain who were racially diverse (Black: n = 258, Latine: n = 254, Asian American: n = 161). The results indicated a positive relationship between stressful life events and centralized pain symptoms (b = 2.53, P < .001) and pain intensity (b = .20, P < .001). In parallel mediation analyses, anger (b = .91, 95% CI = .67, 1.17) and perceived injustice (b = .86, 95% CI = .64, 1.11) acted as partial mediators on centralized pain symptoms. Also, anger (b = .05, 95% CI = .03, .08) and perceived injustice (b = .11, 95% CI = .08, .14) acted as full mediators on pain intensity. The combined psychosocial variables accounted for 51% of centralized pain symptoms and 26% of pain intensity. The findings suggest that psychosocial factors are significantly associated with pain outcomes. Future research is needed to investigate exposure to adversity in life, anger, and perceived injustice together as psychosocial mechanisms of pain symptoms. PERSPECTIVE: Among racially minoritized adults with chronic pain, this article presents empirical evidence that stressful life events, anger, and perceived injustice are associated with centralized pain symptoms and pain intensity. This could guide psychological intervention to focus on anger and perceived injustice, especially when addressing centralized pain.
Collapse
Affiliation(s)
- Joel Jin
- Department of Clinical Psychology, Seattle Pacific University, Seattle, Washington.
| | - Brandon C Yarns
- Department of Mental Health/Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
3
|
Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2415842. [PMID: 38869899 PMCID: PMC11177167 DOI: 10.1001/jamanetworkopen.2024.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
Importance Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed. Objectives To evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms-key targets of EAET-moderate treatment response. Design, Setting, and Participants This 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain. Interventions Emotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions. Main Outcomes and Measures The primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants. Results Among 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, -1.59 [95% CI, -2.35 to -0.83]; P < .001) and follow-up (estimate, -1.01 [95% CI, -1.78 to -0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P < .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, -2.49 [95% CI, -4.30 to -0.68]; P = .006), depression (estimate, -3.06 [95% CI, -5.88 to -0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, -4.39 [95% CI, -8.44 to -0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P < .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P < .001) at posttreatment. Higher baseline depression (estimate, -1.55 [95% CI, -0.37 to 2.73]; P < .001), anxiety (estimate, -1.53 [95% CI, -2.19 to -0.88]; P < .001), and PTSD symptoms (estimate, -1.69 [95% CI, -2.96 to -0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT. Conclusions and Relevance The results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine. Trial Registration ClinicalTrials.gov Identifier: NCT03918642.
Collapse
Affiliation(s)
- Brandon C. Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Nicholas J. Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Alexander Alas
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
| | - Rebecca J. Melrose
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - David L. Sultzer
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Irvine
| |
Collapse
|
4
|
Shahverdi ZA, Dehghani M, Ashouri A, Manouchehri M, Mohebi N. Effectiveness of intensive short-term dynamic psychotherapy for Tension-Type Headache (TTH): A randomized controlled trial of effects on emotion regulation, anger, anxiety, and TTH symptom severity. Acta Psychol (Amst) 2024; 244:104176. [PMID: 38330733 DOI: 10.1016/j.actpsy.2024.104176] [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: 12/27/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Research has demonstrated the potential efficacy of intensive short-term dynamic psychotherapy (ISTDP) in addressing medically unexplained symptoms (MUS). However, the specific application of ISTDP for tension-type headache (TTH), a prevalent and common MUS, has not been extensively studied. In light of this gap in the literature, the current study investigated the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in treating TTH. The study assessed ISTDP's impact on emotion regulation (ER) capacities, levels of anxiety and anger, and TTH symptoms. 30 patients from the neurology clinic at Hazrat Rasool Hospital in Tehran were randomly assigned to either the intervention (n = 15) or control (n = 15) group. Pre- and post-treatment evaluations were conducted, followed by a ten-week follow-up assessment. Data were analyzed using repeated measures analyses of variance. The results indicated that ISTDP led to significant improvements in ER, reductions in anxiety and anger levels, and a significant decrease in TTH symptoms (ps < 0.001). Findings underscore the effectiveness of ISTDP as a valuable therapeutic approach for addressing TTH.
Collapse
Affiliation(s)
- Zahra Ahmadvand Shahverdi
- Department of Clinical Psychology, School of Behavioral Science and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Dehghani
- Department of Clinical Psychology, School of Behavioral Science and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Ashouri
- Department of Clinical Psychology, School of Behavioral Science and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Manouchehri
- Department of Psychology, Faculty of Medical, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Nafiseh Mohebi
- Department of Neurology Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| |
Collapse
|
5
|
Marmuse A, Billaud JB, Jacob S, Vigier C, Ramdani C, Trousselard M. 'Hidden' anger as a risk factor for operational health: An exploratory approach among French military personnel. MILITARY PSYCHOLOGY 2024:1-11. [PMID: 38436979 DOI: 10.1080/08995605.2024.2324645] [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: 07/26/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
Military personnel are repeatedly exposed to multiple stressors, and are sometimes characterized by high levels of anger. Evidence suggests that this anger can become dysfunctional, and impact the health status of populations chronically exposed to stress. In particular, rumination (understood as perseverative thoughts about a past event), provides a theoretical framework for investigating how anger may impact stress regulation abilities in military personnel declared fit for deployment. This exploratory study aimed therefore to examine the impact of the anger profile on psychological suffering in terms of burnout and post-traumatic stress disorder (PTSD), along with the reactivity of the autonomic nervous system, measured as cardiac variability. One hundred and seventeen French soldiers were tested before deployment to Operation BARKHANE. Anger rumination, burnout, and PTSD symptoms were assessed using questionnaires, and cardiac variability was measured as the questionnaires were completed. The results revealed two profiles related to anger trait and anger rumination. Burnout and PTSD scores were higher among military personnel with high levels of anger trait and rumination, and this group also had lower parasympathetic activity and flexibility after completing the questionnaires. These results suggest that there may be a link between an angry profile and psychological suffering, notably burnout and PTSD. Rumination could be involved in this link, as it is associated with poor adaptation to stress in a military context. Prospective researches including post-deployment will establish whether this ruminative response can account for the relationship between problematic anger, stress regulatory capacities and psychological health in military populations.
Collapse
Affiliation(s)
- Anaïs Marmuse
- 9th Army Medical Center, Army Health Service, Draguignan, France
- INSPIIRE, University of Lorraine, Metz Cedex, France
| | - Jean-Baptiste Billaud
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Sandrine Jacob
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Cécile Vigier
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Céline Ramdani
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Marion Trousselard
- INSPIIRE, University of Lorraine, Metz Cedex, France
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
- French Military Health Service Academy, Paris, France
| |
Collapse
|
6
|
Gerrans P. Pain suffering and the self. An active allostatic inference explanation. Neurosci Conscious 2024; 2024:niae002. [PMID: 38348334 PMCID: PMC10860504 DOI: 10.1093/nc/niae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/06/2024] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Distributed processing that gives rise to pain experience is anchored by a multidimensional self-model. I show how the phenomenon of pain asymbolia and other atypical pain-related conditions (Insensitivity to Pain, Chronic Pain, 'Social' Pain, Insensitivity to Pain, Chronic Pain, 'Social' Pain, empathy for pain and suffering) can be explained by this idea. It also explains the patterns of association and dissociation among neural correlates without importing strong modular assumptions. It treats pain processing as a species of allostatic active inference in which the mind co-ordinates its processing resources to optimize basic bodily functioning at different time scales. The self is inferred to be source and target of regulation in this process. The self-modelling account reconciles conflicting deaffectualization and depersonalization accounts of pain asymbolia by showing how depersonalization and pain asymbolia arise at different levels of hierarchical self modelling.
Collapse
Affiliation(s)
- Philip Gerrans
- Department of Philosophy, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
7
|
Vande Vyvere T, De Groote A, De Groef A, Haenen V, Tjalma W, Van Dyck P, Meeus M. Morphological and functional brain changes in chronic cancer-related pain: A systematic review. Anat Rec (Hoboken) 2024; 307:285-297. [PMID: 36342941 DOI: 10.1002/ar.25113] [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: 06/29/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to perform a systematic review of the available literature on morphological and functional brain changes measured by modern neuroimaging techniques in patients suffering from chronic cancer-related pain. A systematic search was conducted in PubMed, Embase, and Web of Science using different keyword combinations. In addition, a hand search was performed on the reference lists and several databases to retrieve supplementary primary studies. Eligible articles were assessed for methodological quality and risk of bias and reviewed by two independent researchers. The search yielded only four studies, three of which used MRI and one PET-CT. None of the studies measured longitudinal morphological (i.e., gray or white matter) changes. All studies investigated functional brain changes and found differences in specific brain regions and networks between patients with chronic cancer-related pain and pain-free cancer patients or healthy volunteers. Some of these alterations were found in brain networks that also show changes in non-cancer populations with chronic pain (e.g., the default mode network and salience network). However, specific findings were inconsistent, and there was substantial variation in imaging methodology, analysis, sample size, and study quality. There is a striking lack of research on morphological brain changes in patients with chronic cancer-related pain. Moreover, only a few studies investigated functional brain changes. In the retrieved studies, there is some evidence that alterations occur in brain networks also involved in other chronic non-cancer pain syndromes. However, the low sample sizes of the studies, finding inconsistencies, and methodological heterogeneity do not allow for robust conclusions.
Collapse
Affiliation(s)
- Thijs Vande Vyvere
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Amber De Groote
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - An De Groef
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Vincent Haenen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Wiebren Tjalma
- Department of Gynecological Oncology, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
8
|
Potegal M. How it ends: A review of behavioral and psychological phenomena, physiological processes and neural circuits in the termination of aggression in other animals and anger in people. Behav Brain Res 2024; 456:114676. [PMID: 37739229 DOI: 10.1016/j.bbr.2023.114676] [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: 06/08/2023] [Revised: 08/26/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023]
Abstract
More is known about aggression initiation and persistence in other animals, and anger in people, than about their cessation. This review summarizes knowledge of relevant factors in aggression, mostly in vertebrates, and anger termination in people. The latency, probability and intensity of offensive aggression in mice is controlled by activity in a neuronal subpopulation in ventromedial hypothalamus [VMH]. This activity instantiates an aggressive state termed angriffsbereitschaft ["attack-readiness"]. Fighting in many species is broken into bouts with interbout breaks due to fatigue and/or signals from dorsal raphe to VMH. Eventually, losers decide durations and outcomes of fighting by transitioning to submission or flight. Factors reducing angriffsbereitschaft and triggering these defeat behaviors could include metabolic costs, e.g., lactate accumulation and glucose depletion detected by the hypothalamus, central fatigue perhaps sensed by the Salience Network [insula and anterior cingulate gyrus] and pain of injuries, the latter insufficiently blunted by opioid and non-opioid stress analgesia and transduced by anterior VMH neurons. Winners' angriffsbereitschaft continue for awhile, as indicated by post-victory attacks and, perhaps, triumph displays of some species, including humans. In longer term situations, sensory and/or response habituation of aggression may explain the "Dear enemy" tolerance of competitive neighbors. Prolonged satiation of predatory behavior could involve habenula-regulated reduction of dopaminergic reward in nucleus accumbens. Termination of human anger involves at least three processes, metaphorically termed decay, quenching and catharsis. Hypothesized neural mechanisms include anger diminution by negative feedback from accumbens to anterior cingulate and/or activity in the Salience Network that controls anger's "accumulation/offset" phase.
Collapse
Affiliation(s)
- M Potegal
- University of Minnesota, United States.
| |
Collapse
|
9
|
Yarns BC, Molaie AM, Lumley MA, Zhu TA, Jazi AN, Ganz DA, Melrose RJ. Video telehealth emotional awareness and expression therapy for older U.S. military veterans with chronic pain: A pilot study. Clin Gerontol 2024; 47:136-148. [PMID: 36541672 DOI: 10.1080/07317115.2022.2159909] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Emotional Awareness and Expression Therapy (EAET) targets trauma and emotional conflict to reduce or eliminate chronic pain, but video telehealth administration is untested. This uncontrolled pilot assessed acceptability, feasibility, and preliminary efficacy of group-based video telehealth EAET (vEAET) for older veterans with chronic musculoskeletal pain. METHODS Twenty veterans were screened, and 16 initiated vEAET, delivered as one 60-minute individual session and eight 90-minute group sessions. Veterans completed posttreatment satisfaction ratings and pain severity (primary outcome), pain interference, anxiety, depression, functioning, social connectedness, shame, and anger questionnaires at baseline, posttreatment, and 2-month follow-up. RESULTS Satisfaction was high, and veterans attended 7.4 (SD = 0.6) of 8 group sessions; none discontinued treatment. Veterans attained significant, large reductions in pain severity from baseline to posttreatment (p < .001, Hedges' g = -1.54) and follow-up (p < .001, g = -1.20); 14 of 16 achieved clinically significant (≥ 30%) pain reduction, and 3 achieved 90-100% pain reduction. Secondary outcomes demonstrated significant, medium-to-large improvements. CONCLUSIONS In this small sample, vEAET produced better attendance, similar benefits, and fewer dropouts than in-person EAET in prior studies. Larger, controlled trials are needed. CLINICAL IMPLICATIONS Group vEAET appears feasible and highly effective for older veterans with chronic pain.
Collapse
Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Ali M Molaie
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - David A Ganz
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Rebecca J Melrose
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| |
Collapse
|
10
|
Espejo EP, Sheridan TM, Pino CA, Phillips CR. Mental Health Predictors of Response to Standard Medical Intervention at a Military Pain Specialty Clinic. Mil Med 2023; 188:149-156. [PMID: 37948258 DOI: 10.1093/milmed/usad060] [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: 11/30/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Chronic pain among active duty service members can negatively impact operational readiness and contributes to significant health care costs within military treatment facilities. Response to standard medical intervention (SMI) for chronic pain is highly variable. The objective of the current study was to examine whether mental health indicators predict individual variation in response to SMI for chronic pain in a military pain specialty clinic. METHODS This is a retrospective observational study of data previously collected at the Pain Medicine Center at Naval Medical Center San Diego (NMCSD) approved by the NMCSD Institutional Review Board. We included 286 ADSMs who completed the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) at two assessment points (mean = 118.45 days apart, SD = 37.22) as part of standard care. Hierarchical linear regression analyses were conducted to examine whether pretreatment mental health measures predict changes in the pain impact score (PIS)-a composite measure of pain intensity, pain interference, and physical functioning-over the course of treatment. RESULTS After controlling for pretreatment PIS, pretreatment PTSD symptoms, fatigue, and anger were all significant predictors of posttreatment PIS: Higher PTSD symptoms, higher fatigue, and lower anger predicted poorer response to treatment (all Ps < .05). CONCLUSION Higher pretreatment PTSD and fatigue symptoms may portend poorer response to SMI for chronic pain. Poor response to treatment may also be predicted by lower pretreatment anger. Further investigation is warranted to identify the best strategies for treating chronic pain in military treatment facilities when these conditions are identified during initial evaluation.
Collapse
Affiliation(s)
- Emmanuel P Espejo
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Tara M Sheridan
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Carlos A Pino
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Christopher R Phillips
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| |
Collapse
|
11
|
Zamir O, Yarns BC, Lagman-Bartolome AM, Jobanputra L, Lawler V, Lay C. Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review. Headache 2023; 63:1031-1039. [PMID: 37638484 DOI: 10.1111/head.14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In this narrative review, we summarize relevant literature pertaining to psychosocial risk factors for headache and migraine progression, current behavioral and psychological treatments, and consider promising treatments. BACKGROUND Headache and migraine are common and associated with significant burden and disability. Current treatments targeting psychosocial risk factors show modest outcomes and do not directly address the impact of early life adversity, including the development of maladaptive emotional processing. An intervention that could address these factors and include components of current evidence-based interventions may lead to improved outcomes. METHODS We searched PubMed and Google Scholar for articles through December 2022. Search terms included headache, migraine, psychological interventions, behavioral interventions, cognitive-behavioral therapy, mindfulness, psychiatric comorbidities, adverse childhood experiences, trauma, and emotional processing. RESULTS Trauma and childhood adversity show a correlation with headache and migraine progression. Developmental adversity and trauma interfere with adaptive emotional processing, which may worsen headache and migraine symptoms, while adaptive ways of experiencing emotions are shown to improve symptoms. Current behavioral and psychological interventions, such as cognitive-behavioral and mindfulness therapies, are effective treatments for headache, but they produce small to medium effect sizes and do not directly address the impact of trauma and emotional conflicts-common factors that contribute to chronicity and disability, especially among certain subpopulations of headache patients such as those with migraine. Thus, there exists a gap in current treatment. CONCLUSION There is a gap in headache and migraine treatment for those patients who have a history of trauma, childhood adversity, and maladaptive emotional processing. We suggest that an integrated psychological treatment that includes components of current evidence-based interventions and addresses gaps by focusing on processing trauma-related emotions may improve chronic and debilitating symptoms.
Collapse
Affiliation(s)
- Orit Zamir
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Wasser Pain Medicine Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ana Marissa Lagman-Bartolome
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Lina Jobanputra
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Lawler
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christine Lay
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Carlson DM, Yarns BC. Managing medical and psychiatric multimorbidity in older patients. Ther Adv Psychopharmacol 2023; 13:20451253231195274. [PMID: 37663084 PMCID: PMC10469275 DOI: 10.1177/20451253231195274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity - the presence of two or more chronic conditions in an individual - which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors - including trauma and racism - that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.
Collapse
Affiliation(s)
- David M. Carlson
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Brandon C. Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg. 401, Rm. A236, Mail Code 116AE, Los Angeles, CA 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| |
Collapse
|
13
|
Körner AJ, Sabatowski R, Kaiser U. [Emotions in chronic pain : Changes in the course of day clinic interdisciplinary multimodal pain therapy]. Schmerz 2023:10.1007/s00482-023-00748-z. [PMID: 37644244 DOI: 10.1007/s00482-023-00748-z] [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: 02/09/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023]
Abstract
RESEARCH QUESTION The present study examined the extent to which emotional experience and emotional competence (EC) change in people with chronic pain during interdisciplinary multimodal pain treatment (IMPT). METHODS The study included N = 184 adult German-speaking individuals with non-cancer-related chronic pain. They completed a day clinic IMPT. The frequency of specific emotions (anger, etc.) and EC was assessed at three measurement time points using the Questionnaire for Emotion-Specific Self-Assessment of Emotional Competencies (ERSQ-ES) and the Emotional Competency Questionnaire (ECQ). The course results were analyzed descriptively, inferentially, and using linear regression. RESULTS Positive emotions were experienced more frequently (effect size r = 0.40; p < 0.001) and negative emotions less frequently (r = 0.39, p < 0.001) at end of therapy. The experience of anger decreased particularly strongly (r = 0.52; p < 0.001). Self-assessed EC did not change during the IMPT (χ2ECQ_total (2) = 0.09; p = 0.956). EC largely explained the variance in the frequency experience of positive (R2 = 0.468) and negative emotions (R2 = 0.390). DISCUSSION Improvements in patient-reported frequencies of positive and negative emotions during IMPT were demonstrated. Further research should validate these results using a control group. Even though no explicit increase in competence was perceivable for the studied subjects, EC had a high predictive value for emotion frequency. Future therapy designs and evaluations should focus more on changes of emotional experience.
Collapse
Affiliation(s)
- Anne Juliane Körner
- UniversitätsSchmerzCentrum (USC), Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Rainer Sabatowski
- UniversitätsSchmerzCentrum (USC), Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Ulrike Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| |
Collapse
|
14
|
Bułdyś K, Górnicki T, Kałka D, Szuster E, Biernikiewicz M, Markuszewski L, Sobieszczańska M. What Do We Know about Nociplastic Pain? Healthcare (Basel) 2023; 11:1794. [PMID: 37372912 PMCID: PMC10298569 DOI: 10.3390/healthcare11121794] [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: 03/22/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of spinal fluid elements, the structure of the white and gray matter of the brain, and psychological aspects. Many different diagnostic tools, i.e., the painDETECT and Douleur Neuropathique 4 questionnaires, have been developed to diagnose neuropathic pain, but they can also be applied for nociplastic pain; however, more standardized instruments are still needed in order to assess its occurrence and clinical presentation. Numerous studies have shown that nociplastic pain is present in many different diseases such as fibromyalgia, complex regional pain syndrome type 1, and irritable bowel syndrome. Current pharmacological and nonpharmacological treatments for nociceptive and neuropathic pain are not entirely suitable for treating nociplastic pain. There is an ongoing effort to establish the most efficient way to manage it. The significance of this field has led to several clinical trials being carried out in a short time. The aim of this narrative review was to discuss the currently available evidence on pathophysiology, associated diseases, treatment possibilities, and clinical trials. It is important that physicians widely discuss and acknowledge this relatively new concept in order to provide optimized pain control for patients.
Collapse
Affiliation(s)
- Kacper Bułdyś
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland
| | - Tomasz Górnicki
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Dariusz Kałka
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
- Men’s Health Centre in Wrocław, 53-151 Wroclaw, Poland
| | - Ewa Szuster
- Cardiosexology Students Club, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | | | - Leszek Markuszewski
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland
| | | |
Collapse
|
15
|
Hu CS, Zhang H, Short LA, Hu S. Individuals with higher suicide risk showed more anger and disgust during rest. DEATH STUDIES 2023; 48:9-15. [PMID: 36906516 DOI: 10.1080/07481187.2023.2186537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Previous research showed that suicide risk was associated with the anger trait and the facial expression of anger when advising on life dilemmas. We investigated if suicide risk was associated with the facial expression of anger during rest, a state when individuals often reflect upon their lives. Participants took a 1-min rest before being assessed for suicide risk. We measured 147 participants' frontal-view facial expressions during their rest 1475-3694 times using automated facial expression analysis technology. Participants' suicide risk was significantly positively correlated with their anger and disgust during the rest, which may be related to psychological pain and death-related thoughts among individuals with suicide risk. Therefore, rest for clinical patients should not be seen simply as a "rest" for the mind. Rather, for counselors, rest may open a window to look into patients' inner thoughts that may be important to their lives.
Collapse
Affiliation(s)
- Chao S Hu
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
- Psychological Research & Education Center, School of Humanities, Southeast University, Nanjing, China
| | - Haotian Zhang
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, China
| | - Lindsey A Short
- Department of Psychology, Redeemer University, Ancaster, Canada
| | - Shuhua Hu
- Department of Psychology, Jinghengyi Education School, Hangzhou Normal University, Hangzhou, China
| |
Collapse
|
16
|
Miles SR, Martindale SL, Flanagan JC, Troyanskaya M, Reljic T, Gilmore AK, Wyant H, Nakase-Richardson R. Putting the pieces together to understand anger in combat veterans and service members: Psychological and physical contributors. J Psychiatr Res 2023; 159:57-65. [PMID: 36657315 DOI: 10.1016/j.jpsychires.2023.01.013] [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] [Received: 09/13/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for the association between PTSD and anger, in addition to the association between pain interference and anger. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Additionally, treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference.
Collapse
Affiliation(s)
- Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Sarah L Martindale
- W.G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | - Maya Troyanskaya
- Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Tea Reljic
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Hannah Wyant
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Traumatic Brain Injury Center of Excellence, Defense Health Agency, James A. Haley Veterans' Hospital, Tampa, FL, USA; Pulmonary and Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
| |
Collapse
|
17
|
Macionis V. Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion. FRONTIERS IN PAIN RESEARCH 2023; 4:1037376. [PMID: 36890855 PMCID: PMC9986610 DOI: 10.3389/fpain.2023.1037376] [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: 09/05/2022] [Accepted: 01/12/2023] [Indexed: 02/22/2023] Open
Abstract
It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.
Collapse
|
18
|
Yarns BC, Zhu TA, Najafian Jazi A. Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach. Am J Geriatr Psychiatry 2022; 30:1342-1350. [PMID: 35999127 DOI: 10.1016/j.jagp.2022.07.009] [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: 03/01/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Chronic pain remains a serious healthcare challenge, particularly for older adults who suffer substantial disability and are susceptible to serious risks from pain medications and invasive procedures. Psychotherapy is a promising option for older adults with chronic pain, since it does not contribute to medical or surgical risks. However, standard psychotherapies for chronic pain, including cognitive-behavioral therapy (CBT), acceptance and commitment therapy, and mindfulness-based interventions, produce only modest and time-limited benefits for older adults. In this article, we describe a novel, evidence-based psychological assessment and treatment approach for older adults with chronic pain, including a detailed case example. The approach begins with reviewing patients' pain, psychosocial, and medical histories to elicit evidence of a subtype of chronic pain called centralized (primary, nociplastic, or psychophysiologic) pain, which is highly influenced and may even be caused by life stress, emotions, and alterations in brain function. Patients then undertake a novel psychotherapy approach called emotional awareness and expression therapy (EAET) that aims to reduce or eliminate centralized pain by resolving trauma and emotional conflicts and learning healthy communication of adaptive emotions. Our published preliminary clinical trial (n = 53) indicated that EAET produced statistically significant and large effect size advantages over CBT in pain reduction and marginally greater improvements in pain interference than CBT for older adults with chronic musculoskeletal pain. Geriatric mental healthcare providers may learn this assessment and treatment approach to benefit many of their patients with chronic pain.
Collapse
Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA.
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
| |
Collapse
|
19
|
Serrano PV, Zortea M, Alves RL, Beltran G, Deliberali CB, Maule A, Torres ILS, Fregni F, Caumo W. Association between descending pain modulatory system and cognitive impairment in fibromyalgia: A cross-sectional exploratory study. Front Behav Neurosci 2022; 16:917554. [PMID: 36248031 PMCID: PMC9559397 DOI: 10.3389/fnbeh.2022.917554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background The successful regulation of sensory input to the central nervous system depends on the descending pain modulatory system (DPMS). For the effective regulation of sensory input to the central nervous system and behavioral responses to pain, the DPMS is required. Its connection to fibromyalgia (FM)-related cognitive dysfunction has not yet been investigated. Therefore, this study tested whether measures of verbal fluency, sustained attention, and short-term and working memory could distinguish FM patients from healthy controls (HC). Additionally, it investigated, using a standardized paradigm, the link between cognitive ability and the function of the DPMS in responders and non-responders to the conditioned pain modulation test (CPM-test). Materials and methods We enrolled 21 HC women and 69 FM patients, all of whom ranged in age from 30 to 65. We employed scores from the Trail Making Test (TMTB-A) (sustained and divided attention), the Controlled Oral Word Association Test (COWAT) (orthographic and semantic fluency), and the Digits subtest of the Wechsler Adult Intelligence Scale (WAIS-III) as dependent variables. Results A generalized linear model (GLM) adjusted by educational level revealed significantly lower scores in FM than HC on the Span digits forward, COWAT-orthographic, and TMTB-A. For FM patients, multilevel MANCOVA revealed that the cognitive performance of non-responders compared to responders to CPM-test showed lower adjusted scores in Span digits forward (Partial-η2 = 0.358, P = 0.001), Span digits backward (Partial-η2 = 0.358, P = 0.001), COWAT-orthographic (Partial-η2 = 0.551, P = 0.001), COWAR-semantic (Partial-η2 = 0.355, P = 0.001), and TMTB-A (Partial-η2 = 0.360, P = 0.001). The association between the cognitive tests and the DPMS is moderated by the serum level of brain-derived neurotrophic factor (BDNF). Additionally, these cognitive assessments had a positive correlation with antidepressant use and pain threshold. The cognitive assessments, on the other hand, were conversely associated with a life of quality. Conclusion Based on these findings, it can be shown that HC performed substantially better on cognitive exams than FM did. They demonstrated a link between clinical complaints about attention and memory and decreased DPMS effectiveness. Additionally, they demonstrated that the BDNF is a moderating element in a potential relationship between the severity of cognitive impairment and DPMS dysfunction.
Collapse
Affiliation(s)
- Paul Vicuña Serrano
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Psychology, UNISINOS, São Leopoldo/Porto Alegre, Brazil
| | - Rael Lopes Alves
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gerardo Beltran
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Institute of Neurosciences, Universidad Catolica de Cuenca (UCACUE), Cuenca, Ecuador
| | | | - Amanda Maule
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Iraci L. S. Torres
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Department of Physics and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- *Correspondence: Wolnei Caumo,
| |
Collapse
|