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Jones HG, Rizzo RRN, Pulling BW, Braithwaite FA, Grant AR, McAuley JH, Jensen MP, Moseley GL, Rees A, Stanton TR. Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis. Pain Rep 2024; 9:e1185. [PMID: 39263007 PMCID: PMC11390056 DOI: 10.1097/pr9.0000000000001185] [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: 10/20/2023] [Revised: 06/17/2024] [Accepted: 07/12/2024] [Indexed: 09/13/2024] Open
Abstract
Systematic reviews suggest that stand-alone hypnotic suggestions may improve pain outcomes compared with no treatment, waitlist, or usual care. However, in clinical practice, hypnosis is often provided adjunctively with other interventions, which might have different effects than those reported in previous reviews. This systematic review aimed to summarize the analgesic effects of adjunctive hypnosis in adults with clinical pain. Seven databases (MEDLINE, Embase, PsycINFO, Emcare, SCOPUS, CENTRAL, Cochrane) were searched up to January 2024. Randomised controlled trials comparing the analgesic effects of adjunctive hypnosis (hypnosis + primary intervention) with those of the primary intervention alone were included. Meta-analyses (random-effects model) calculated mean differences (MD, [95% confidence intervals]) for pain intensity (0-100). Seventy studies were pooled in meta-analyses (n = 6078). Hypnosis adjunctive to usual care had a small additional analgesic effect (chronic pain: -8.2 [-11.8, -1.9]; medical procedures/surgical pain: -6.9 [-10.4, -3.3]; burn wound care: -8.8 [-13.8, -3.9]). Hypnosis adjunctive to education had a medium additional analgesic effect for chronic pain (-11.5 [-19.7, 3.3]) but not postsurgery pain (-2.0 [-7.8, 3.7]). When paired with psychological interventions, hypnosis slightly increased analgesia in chronic pain only at the three-month follow-up (-2 [-3.7, -0.3]). Hypnosis adjunctive to medicines had a medium additional analgesic effect for chronic pain (-13.2, [-22.5, -3.8]). The overall evidence certainty is very low; therefore, there is still uncertainty about the analgesic effects of adjunctive hypnosis. However, hypnosis adjunct to education may reduce pain intensity for chronic pain. Clarification of proposed therapeutic targets of adjunctive hypnosis to evaluate underlying mechanisms is warranted.
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Affiliation(s)
- Hannah G Jones
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Psychological Medicine, Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian W Pulling
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, South Australian Health and Medical Research Institute (SAHMRI), Lifelong Health Theme, Hopwood Centre for Neurobiology, Adelaide, South Australia, Australia
| | - Felicity A Braithwaite
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, South Australian Health and Medical Research Institute (SAHMRI), Lifelong Health Theme, Hopwood Centre for Neurobiology, Adelaide, South Australia, Australia
| | - Ashley R Grant
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Amy Rees
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, South Australian Health and Medical Research Institute (SAHMRI), Lifelong Health Theme, Hopwood Centre for Neurobiology, Adelaide, South Australia, Australia
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Hedman-Lagerlöf M, Gasslander N, Ahnlund Hoffmann A, Bragesjö M, Etzell A, Ezra S, Frostell E, Hedman-Lagerlöf E, Ivert C, Liliequist B, Ljótsson B, Hoppe JM, Palmgren J, Spansk E, Sundström F, Särnholm J, Tzavara G, Buhrman M, Axelsson E. Effect of exposure-based vs traditional cognitive behavior therapy for fibromyalgia: a two-site single-blind randomized controlled trial. Pain 2024; 165:1278-1288. [PMID: 38131181 PMCID: PMC11090030 DOI: 10.1097/j.pain.0000000000003128] [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: 06/27/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 12/23/2023]
Abstract
ABSTRACT Fibromyalgia is a debilitating pain condition for which treatment effects are typically modest. The most evaluated psychological treatment is traditional cognitive behavior therapy (T-CBT), but promising effects have recently been seen in exposure-based cognitive behavior therapy (Exp-CBT). We investigated whether Exp-CBT was superior to T-CBT in a randomized controlled trial. Self-referred participants with fibromyalgia (N = 274) were randomized (1:1) to 10 weeks of Exp-CBT or T-CBT. Treatments were delivered online and presented as "CBT for fibromyalgia." Participants were assessed at baseline, weekly during treatment, posttreatment, and at 6- and 12-month follow-up. Primary outcome was the difference in reduction in fibromyalgia severity as measured using the Fibromyalgia Impact Questionnaire (FIQ) over 11 assessment points from baseline to posttreatment, modelled within an intention-to-treat framework using linear mixed effects models fitted on multiple imputed data. Approximately 91% of weekly FIQ scores were collected over the main phase. There was no significant difference between Exp-CBT and T-CBT in the mean reduction of fibromyalgia severity from pretreatment to posttreatment (b = 1.3, 95% CI -3.0 to 5.7, P = 0.544, d = -0.10). Minimal clinically important improvement was seen 60% in Exp-CBT vs 59% in T-CBT. Effects were sustained up to 12 months posttreatment. This well-powered randomized trial indicated that Exp-CBT was not superior to T-CBT for fibromyalgia. Both treatments were associated with a marked reduction in fibromyalgia severity, and the online treatment format might be of high clinical utility. T-CBT can still be regarded a reference standard treatment that remains clinically relevant when compared to novel treatment approaches.
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Affiliation(s)
- Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nils Gasslander
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Alice Ahnlund Hoffmann
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Bragesjö
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Amanda Etzell
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Simon Ezra
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Elsa Frostell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Caroline Ivert
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Björn Liliequist
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johanna M. Hoppe
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Josefin Palmgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Edward Spansk
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Felicia Sundström
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Josefin Särnholm
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Georgia Tzavara
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
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3
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Burns JW, Jensen MP, Thorn BE, Lillis TA, Carmody J, Gerhart J, Keefe F. Cognitive Therapy, Mindfulness-Based Stress Reduction, and Behavior Therapy for the Treatment of Chronic Pain: Predictors and Moderators of Treatment Response. THE JOURNAL OF PAIN 2024; 25:104460. [PMID: 38199593 DOI: 10.1016/j.jpain.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Psychosocial interventions for people with chronic pain produce significant improvements in outcomes, but these effects on average are modest with much variability in the benefits conferred on individuals. To enhance the magnitude of treatment effects, characteristics of people that might predict the degree to which they respond more or less well could be identified. People with chronic low back pain (N = 521) participated in a randomized controlled trial which compared cognitive therapy, mindfulness-based stress reduction, behavior therapy and treatment as usual. Hypotheses regarding predictors and/or moderators were based on the Limit, Activate, and Enhance model; developed to predict and explain moderators/predictors of psychosocial pain treatments. Results were: 1) low levels of cognitive/behavioral function at pre-treatment predicted favorable pre- to post-treatment outcomes; 2) favorable expectations of benefit from treatment and sound working alliances predicted favorable pre- to post-treatment outcomes; 3) women benefited more than men. These effects emerged without regard to treatment condition. Of note, high levels of cognitive/behavioral function at pre-treatment predicted favorable outcomes only for people in the treatment as usual condition. Analyses identified a set of psychosocial variables that may act as treatment predictors across cognitive therapy, mindfulness-based stress reduction and behavior therapy, as hypothesized by the Limit, Activate, and Enhance model if these 3 treatments operate via similar mechanisms. Findings point toward people who may and who may not benefit fully from the 3 psychosocial treatments studied here, and so may guide future research on matching people to these kinds of psychosocial approaches or to other (eg, forced-based interventions) non-psychosocial approaches. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT02133976. PERSPECTIVE: This article examines potential predictors/moderators of response to psychosocial treatments for chronic pain. Results could guide efforts to match people to the most effective treatment type or kind.
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Affiliation(s)
- John W Burns
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | | | - Teresa A Lillis
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - James Carmody
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School
| | - James Gerhart
- Department of Psychology Central Michigan University
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
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Jensen MP, Barrett TD. The Role of Electroencephalogram-Assessed Bandwidth Power in Response to Hypnotic Analgesia. Brain Sci 2024; 14:557. [PMID: 38928559 PMCID: PMC11201437 DOI: 10.3390/brainsci14060557] [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: 02/11/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Research supports the efficacy of therapeutic hypnosis for reducing acute and chronic pain. However, little is known about the mechanisms underlying these effects. This paper provides a review of the evidence regarding the role that electroencephalogram-assessed bandwidth power has in identifying who might benefit the most from hypnotic analgesia and how these effects occur. Findings are discussed in terms of the slow wave hypothesis, which posits that brain activity in slower bandwidths (e.g., theta and alpha) can facilitate hypnosis responsivity. Although the extant research is limited by small sample sizes, the findings from this research are generally consistent with the slow wave hypothesis. More research, including and especially studies with larger sample sizes, is needed to confirm these preliminary positive findings.
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Affiliation(s)
- Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA;
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5
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Castillo-Rangel C, Gallardo-García ES, Fadanelli-Sánchez F, Hernández-Peña VS, Trujillo-Ramírez AM, López-Gómez EDC, García LI, Iñiguez-Luna MI, Martínez-Bretón P, Ramírez-Rodríguez R, Ordoñez-Granja J, Trujillo-Aboite MG, Marín G. Minimally Invasive Treatment of Facet Osteoarthritis Pain in Spine: A Clinical Approach Evaluating Cryotherapy. World Neurosurg 2024; 185:e741-e749. [PMID: 38423456 DOI: 10.1016/j.wneu.2024.02.122] [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: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Chronic pain management remains a challenging aspect of neurosurgical care, with facet arthrosis being a significant contributor to the global burden of low back pain. This study evaluates the effectiveness of cryotherapy as a minimally invasive treatment for patients with facet arthrosis. By focusing on reducing drug dependency and pain intensity, the research aims to contribute to the evolving field of pain management techniques, offering an alternative to traditional pain management strategies. METHODS Through a retrospective longitudinal analysis of patients with facet osteoarthritis treated via cryotherapy between 2013 and 2023, we evaluated the impact on medication usage and pain levels, utilizing the Visual Analog Scale for pre- and posttreatment comparisons. RESULTS The study encompassed 118 subjects, revealing significant pain alleviation, with Visual Analog Scale scores plummeting from 9.0 initially to 2.0 after treatment. Additionally, 67 patients (56.78%) reported decreased medication consumption. These outcomes underscore cryotherapy's potential as a pivotal tool in chronic pain management. CONCLUSIONS The findings illuminate cryotherapy's efficacy in diminishing pain and curtailing medication dependency among patients with facet arthrosis. This study reaffirms cryotherapy's role in pain management and propels the discourse on nontraditional therapeutic avenues, highlighting the urgent need for personalized and innovative treatment frameworks.
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Affiliation(s)
- Carlos Castillo-Rangel
- Department of Neurosurgery, "Hospital Regional 1◦ de Octubre", Institute of Social Security and Services for State Workers (ISSSTE), Mexico City, Mexico
| | | | | | | | - Alex Missael Trujillo-Ramírez
- Faculty of Medicine campus Cd. Mendoza, Universidad Veracruzana, Camerino Z Mendoza, Veracruz, Mexico; Faculty of Medicine, Universidad Veracruzana, Veracruz, Mexico
| | | | - Luis I García
- Department of Biophysics, Brain Research Institute, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | | | | | | | - Jaime Ordoñez-Granja
- Department of Neurosurgery, "Hospital Regional 1◦ de Octubre", Institute of Social Security and Services for State Workers (ISSSTE), Mexico City, Mexico
| | | | - Gerardo Marín
- Neural Dynamics and Modulation Lab, Cleveland Clinic, Cleveland, Ohio, USA.
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6
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Horton DM, Woods DK, Garland EL, Edwards RR, Barrett B, Zgierska AE. Qualitative findings from a randomized trial of mindfulness-based and cognitive-behavioral group therapy for opioid-treated chronic low back pain. J Health Psychol 2024:13591053241247710. [PMID: 38679890 DOI: 10.1177/13591053241247710] [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: 05/01/2024] Open
Abstract
This article reports qualitative outcomes from a randomized controlled trial comparing eight weeks of cognitive-behavioral group therapy for chronic pain (CBT-CP) and mindfulness-based group therapy (MBT) in individuals with chronic low back pain (CLBP). Approximately 10 months post-treatment, 108 participants completed structured qualitative interviews to express how the study treatment affected their life or health. Responses were qualitatively analyzed to generate a set of themes and subthemes, with between-groups comparisons to evaluate differences (if any) in treatment-response between MBT and CBT-CP. A majority of participants (n = 88, 81.5%) across both groups reflected positively on the study intervention and outcomes, identifying benefits in pain management (31.5%), meditation and mindfulness skills (25.9%), and relaxation skills (22.2%). Perceived benefits varied widely, suggesting no one intervention may be ideal for CLBP. Future research should examine tailoring interventions to target diverse clinical presentations to achieve optimal outcomes.
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Affiliation(s)
- David M Horton
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, USA
| | - David K Woods
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, USA
| | | | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, Brigham and Women's Hospital, USA
| | - Bruce Barrett
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, USA
| | - Aleksandra E Zgierska
- Department of Family and Community Medicine, The Pennsylvania State University College of Medicine, USA
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7
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Donovan E, Green V, Feldman G, Tachdjian R, Curry C, Rice C, Zeltzer LK. The acceptability of Songs of Love for youth living with chronic pain. Int J Adolesc Med Health 2024; 36:161-168. [PMID: 38332697 DOI: 10.1515/ijamh-2023-0176] [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: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Music is helpful to young people in healthcare contexts, but less is known about the acceptability of music-based interventions for youth living at home with chronic pain who may be struggling to attend school and participate in social activities. The Songs of Love (SOL) foundation is a national nonprofit organization that creates free, personalized, original songs for youth facing health challenges. The aims of this study were (1) to assess acceptability of SOL from the perspective of youth with chronic pain receiving a song and singer-songwriters who created the songs, and (2) to explore the role of music more generally in the lives of young people living with pain. METHODS Twenty-three people participated. Fifteen youth (mean age 16.8) were interviewed and received a song, and six singer-songwriters were interviewed about creating the songs. (Two additional people participated in pilot interviews.) Acceptability was assessed by (1) proportion of youth who participated in a second interview about their song and (2) results of reflexive thematic analysis (RTA) to determine acceptability. Themes addressing the role of music in the lives of youth with pain were also explored using RTA. RESULTS The program was acceptable as 12 of 15 youth (80 %) participated in second interviews and themes met the definition of acceptability. Three themes addressing the role of music in the lives of youth living with pain were identified. CONCLUSIONS This is the first report of the acceptability and experience of SOL and contributes to research on the benefits of music for pain management.
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Affiliation(s)
| | - Vanya Green
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
| | - Greg Feldman
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Raffi Tachdjian
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Children's Music Fund, Los Angeles, CA, USA
| | - Caitlin Curry
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Charlotte Rice
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Lonnie K Zeltzer
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
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8
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Day MA, Ehde DM, Bindicsova I, Jensen MP. Understanding the Role of Therapist Quality in Accounting for Heterogeneity of Patient Outcomes in Psychosocial Chronic Pain Treatments. THE JOURNAL OF PAIN 2024; 25:843-856. [PMID: 37832902 DOI: 10.1016/j.jpain.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
A variety of evidence-based psychosocial treatments now exist for chronic pain. However, on average, effect sizes have tended to be modest and there is a high degree of heterogeneity in treatment response. In this focus article, we explore the potential role that therapist quality in delivering treatment may have in accounting for a degree of this variability in outcome. Therapist quality refers to the skillful delivery of treatment, harnessing both specific and common therapeutic factors during sessions. While recognized as important to assess and report in clinical trials by some reporting guidelines, few randomized controlled trials evaluating psychosocial treatments for chronic pain have reported on therapist factors. We reviewed the clinical trials included in three systematic reviews and meta-analyses of trials of cognitive-behavioral therapy (mainly), mindfulness-based interventions, and acceptance and commitment therapy. We found that of the 134 trials included, only nine assessed and reported therapist quality indicators, with a variety of procedures used. This is concerning as without knowledge of the quality in which treatments are delivered, the estimates of effect sizes reported may be misrepresented. We contextualize this finding by drawing on the broader psychotherapy literature which has shown that more skillful, effective therapists demonstrated ten times better patient response rates. Examination of the characteristics associated with these more effective therapists tends to indicate that skillful engagement of common factors in therapy sessions represents a distinguishing feature. We conclude by providing recommendations for assessing and reporting on therapist quality within clinical trials evaluating psychosocial treatments for chronic pain. PERSPECTIVE: Therapist quality in the delivery of psychosocial treatments for chronic pain has rarely been assessed in clinical trials. We propose that therapist quality indicators are an under-studied mechanism that potentially contributes to the heterogeneity of treatment outcomes. We provide recommendations for assessing and reporting on therapist quality in future trials.
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Affiliation(s)
- Melissa A Day
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine, The University of Washington, Seattle, Washington
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, The University of Washington, Seattle, Washington
| | - Ingrid Bindicsova
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, The University of Washington, Seattle, Washington
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Villarreal-Zegarra D, Yllescas-Panta T, Malaquias-Obregon S, Dámaso-Román A, Mayo-Puchoc N. Effectiveness of animal-assisted therapy and pet-robot interventions in reducing depressive symptoms among older adults: A systematic review and meta-analysis. Complement Ther Med 2024; 80:103023. [PMID: 38232905 DOI: 10.1016/j.ctim.2024.103023] [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: 11/03/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Systematic reviews suggest that animal-assisted therapy (AAT) and pet-robot interventions (PRI) achieve a reduction in mental health variables such as depressive symptoms. However, these systematic reviews include both randomised and non-randomised studies, which prevents an adequate assessment of the effect of confounding variables. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of AAT and PRI through randomized controlled trials (RCTs) in reducing depression in older adults. METHODS Our study is a systematic review. We searched three databases of scientific articles: SCOPUS, Web of Science and PubMed. We included studies that their population was older adults, aged 65 years or older, with or without a clinical condition, clinical diagnosis based on mental examination/test or documentation from medical records, accredited by the facilities' staff. We included trials in which the comparator was a passive intervention or an active intervention. We used the Cochrane risk-of-bias tool for randomised trials (RoB 2) to assess the risk of bias for each study. Our study was registered in PROSPERO (CRD42023393740). RESULTS Twenty-three studies were included in this systematic review. However, only 19 trials were included in the meta-analysis. At the overall risk of bias level, 78.9% of the studies were at high risk of bias (n = 15). We found that AAT (g= -0.72; 95%CI -1.13 to -0.31; p = 0.001) has a moderate and statistically significant effect as an intervention to reduce depressive symptoms in older adults. However, the PRIs do not show a significant effect on reducing depressive symptoms in older adults. In addition, a sub-analysis based on dog-assisted therapy (g= -0.65; 95%CI -1.21 to -0.08; p = 0.025), a specific type of AAT, showed a modest effect on reducing depressive symptoms. CONCLUSIONS Our study concluded that AAT and DAT had a moderate and statistically significant effect as interventions to reduce depressive symptoms in older adults. On the other hand, PRI did not show a significant effect in reducing depressive symptoms.
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Affiliation(s)
- David Villarreal-Zegarra
- Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru; Instituto Peruano de Orientación Psicológica, Lima, Peru.
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Gerdle B, Dragioti E, Rivano Fischer M, Ringqvist Å. Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Pain Res 2024; 17:83-105. [PMID: 38196970 PMCID: PMC10775695 DOI: 10.2147/jpr.s438260] [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] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
Background Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008-2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims. Results Changes in acceptance (β:0.424-0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177-0.233; all P<0.001) and changes in fear-avoidance (β: -0.152- -0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator. Discussion and Conclusion Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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Murray GM, Sessle BJ. Pain-sensorimotor interactions: New perspectives and a new model. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 15:100150. [PMID: 38327725 PMCID: PMC10847382 DOI: 10.1016/j.ynpai.2024.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/25/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
How pain and sensorimotor behavior interact has been the subject of research and debate for many decades. This article reviews theories bearing on pain-sensorimotor interactions and considers their strengths and limitations in the light of findings from experimental and clinical studies of pain-sensorimotor interactions in the spinal and craniofacial sensorimotor systems. A strength of recent theories is that they have incorporated concepts and features missing from earlier theories to account for the role of the sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions of pain in pain-sensorimotor interactions. Findings acquired since the formulation of these recent theories indicate that additional features need to be considered to provide a more comprehensive conceptualization of pain-sensorimotor interactions. These features include biopsychosocial influences that range from biological factors such as genetics and epigenetics to psychological factors and social factors encompassing environmental and cultural influences. Also needing consideration is a mechanistic framework that includes other biological factors reflecting nociceptive processes and glioplastic and neuroplastic changes in sensorimotor and related brain and spinal cord circuits in acute or chronic pain conditions. The literature reviewed and the limitations of previous theories bearing on pain-sensorimotor interactions have led us to provide new perspectives on these interactions, and this has prompted our development of a new concept, the Theory of Pain-Sensorimotor Interactions (TOPSMI) that we suggest gives a more comprehensive framework to consider the interactions and their complexity. This theory states that pain is associated with plastic changes in the central nervous system (CNS) that lead to an activation pattern of motor units that contributes to the individual's adaptive sensorimotor behavior. This activation pattern takes account of the biological, psychological, and social influences on the musculoskeletal tissues involved in sensorimotor behavior and on the plastic changes and the experience of pain in that individual. The pattern is normally optimized in terms of biomechanical advantage and metabolic cost related to the features of the individual's musculoskeletal tissues and aims to minimize pain and any associated sensorimotor changes, and thereby maintain homeostasis. However, adverse biopsychosocial factors and their interactions may result in plastic CNS changes leading to less optimal, even maladaptive, sensorimotor changes producing motor unit activation patterns associated with the development of further pain. This more comprehensive theory points towards customized treatment strategies, in line with the management approaches to pain proposed in the biopsychosocial model of pain.
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Affiliation(s)
- Greg M. Murray
- Discipline of Restorative and Reconstructive Dentistry, Sydney School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Darcy Road, Westmead, NSW 2145, Australia
| | - Barry J. Sessle
- Faculty of Dentistry and Temerty Faculty of Medicine Department of Physiology, and Centre for the Study of Pain, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada
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Escriva-Boulley G, Philip CA, Warembourg S, Lenotre L, Flore P, Faure P, Michy T, Letouzey V, Arnold C, Piluso C, Chalmel L, Kacem R, Blum GF, Detayrac R, Trocmé C, Brigaud I, Herbach U, Branche P, Faller E, Chalabaev A. Effects of a physical activity and endometriosis-based education program delivered by videoconference on endometriosis symptoms: the CRESCENDO program (inCRease physical Exercise and Sport to Combat ENDOmetriosis) protocol study. Trials 2023; 24:759. [PMID: 38012776 PMCID: PMC10680283 DOI: 10.1186/s13063-023-07792-1] [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: 08/17/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Endometriosis is a chronic disease characterized by growth of endometrial tissue outside the uterine cavity which could affect 200 million women (The term "woman" is used for convenience. Individuals gendered as man or as nonbinary can also suffer from this disease) worldwide. One of the most common symptoms of endometriosis is pelvic chronic pain associated with fatigue. This pain can cause psychological distress and interpersonal difficulties. As for several chronic diseases, adapted physical activity could help to manage the physical and psychological symptoms. The present study will investigate the effects of a videoconference-based adapted physical activity combined with endometriosis-based education program on quality of life, pain, fatigue, and other psychological symptoms and on physical activity. METHODS This multicentric randomized-controlled trial will propose to 200 patients with endometriosis to be part of a trial which includes a 6-month program with 45 min to more than 120 min a week of adapted physical activity and/or 12 sessions of endometriosis-based education program. Effects of the program will be compared to a control group in which patients will be placed on a waiting list. All participants will be followed up 3 and 6 months after the intervention. None of the participants will be blind to the allocated trial arm. The primary outcome measure will be quality of life. Secondary outcomes will include endometriosis-related perceived pain, fatigue, physical activity, and also self-image, stereotypes, motivational variables, perceived support, kinesiophobia, basic psychological need related to physical activity, and physical activity barriers. General linear models and multilevel models will be performed. Predictor, moderator, and mediator variables will be investigated. DISCUSSION This study is one of the first trials to test the effects of a combined adapted physical activity and education program for improving endometriosis symptoms and physical activity. The results will help to improve care for patients with endometriosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT05831735 . Date of registration: April 25, 2023.
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Affiliation(s)
- Géraldine Escriva-Boulley
- Université de Haute-Alsace, Université de Strasbourg, Université de Lorraine, LISEC UR 2310, F-68100, Mulhouse, France.
| | - Charles-André Philip
- Clinique gynécologique et obstétricale, Hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317, Lyon cedex, France
| | - Sophie Warembourg
- Clinique gynécologique et obstétricale, Hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317, Lyon cedex, France
| | - Lionel Lenotre
- Faculté des Sciences et Techniques, Université de Haute-Alsace, 18 Rue des Frères Lumière, 68200, Mulhouse, France
- PASTA - Processus aléatoires spatio-temporels et leurs applications, Inria Nancy - Grand Est, Villers-lès-, Nancy, France
| | - Patrice Flore
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000, Grenoble, France
| | - Patrice Faure
- Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Thierry Michy
- Department of Gynecology, Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | | | - Carole Arnold
- Université de Lorraine, Inserm, UMRS 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, F-54000, Nancy, France
| | - Claire Piluso
- Université de Haute-Alsace, Université de Strasbourg, SAGE, F-68100, Mulhouse, France
| | - Loic Chalmel
- Université de Haute-Alsace, Université de Strasbourg, Université de Lorraine, LISEC UR 2310, F-68100, Mulhouse, France
| | - Ramzi Kacem
- Service gynécologie GHRMSA, Hôpital Emile Muller, Mulhouse, France
| | - Georges Fabrice Blum
- Cabinet Médical, Clinique du Diaconat-Fonderie et Université de Haute-Alsace, Mulhouse, France
| | | | - Candice Trocmé
- Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Isabelle Brigaud
- Université de Haute-Alsace, CNRS, IS2M UMR 7361, Mulhouse, France
| | - Ulysse Herbach
- Université de Lorraine, CNRS, Inria, IECL, F-54000, Nancy, France
| | - Patricia Branche
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, F-69317, Lyon, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg, France
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Parchment A, Lawrence W, Rahman E, Townsend N, Wainwright E, Wainwright D. 'Making every contact count' with patients with musculoskeletal conditions: a qualitative exploration of acceptability to physiotherapists. BMC Health Serv Res 2023; 23:1125. [PMID: 37858090 PMCID: PMC10588214 DOI: 10.1186/s12913-023-10126-1] [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: 11/18/2022] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
AIM To qualitatively explore physiotherapists' experiences and acceptability of implementing 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) in routine practice with patients with musculoskeletal (MSK) conditions. METHODS This article reports the second phase of a mixed method, sequential explanatory study. Physiotherapists trained in and delivering MECC HCS in their practice were invited to take part in semi-structured interviews. We hoped to develop a rich, in-depth understanding of their use and perceptions of the brief intervention and to contextualise findings from the first phase of the study. Qualitative data were analysed using Reflexive Thematic Analysis. RESULTS Physiotherapists valued MECC HCS as being integral to their practice, promoting a person-centred approach to supporting behaviour change and enhancing self-management in patients with MSK conditions and pain. It was believed that this brief intervention could reduce workload pressure for physiotherapists and have significant wider benefits for health services. Time limitations associated with appointments did, however, pose as a challenge to MECC HCS delivery, and it was felt that more organisational-level support was needed to sustain it. CONCLUSIONS These findings support our quantitative data, collected in the first phase of this study. MECC HCS is a highly acceptable brief intervention that can be delivered in physiotherapy care to support behaviour change in patients with MSK conditions. Future roll-out may be optimised within organisations by providing regular refresher training and adopting a MECC champion.
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Affiliation(s)
- Amelia Parchment
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK.
- NIHR Applied Research Collaboration- Greater Manchester, University of Manchester, Manchester, M13 9PL, England.
| | - Wendy Lawrence
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, England, UK
| | - Em Rahman
- Public Health Workforce Development, Southern House, Health Education England, Winchester, SO21 2RU, England, UK
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, England, UK
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - David Wainwright
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK
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Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep 2023; 8:e1092. [PMID: 37719924 PMCID: PMC10501475 DOI: 10.1097/pr9.0000000000001092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/19/2023] [Accepted: 06/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome. This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP. Methods Data from a randomized controlled trial with 2 treatment arms (exposure treatment based on the FAM with/without in-session exposure) was pooled, including only participants with complete data (N = 69). Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses. Results Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure. The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled. Conclusions The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C. Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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15
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McDaniel AL, Dimitrov TN, Bruehl SP, Monroe TB, Failla MD, Cowan RL, Ryan C, Anderson AR. Psychophysics of Pain: A Methodological Introduction. Pain Manag Nurs 2023; 24:442-451. [PMID: 36948969 PMCID: PMC10440278 DOI: 10.1016/j.pmn.2023.02.006] [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: 06/28/2022] [Revised: 12/29/2022] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
For over 100 years, psychophysics ..÷ the scientific study between physical stimuli and sensation ... has been successfully employed in numerous scientific and healthcare disciplines, as an objective measure of sensory phenomena. This manuscript provides an overview of fundamental psychophysical concepts, emphasizing pain and research application..÷defining common terms, methods, and procedures.Psychophysics can provide systematic and objective measures of sensory perception that can be used by nursing scientists to explore complex, subjective phenomena..÷such as pain perception. While there needs to be improved standardization of terms and techniques, psychophysical approaches are diverse and may be tailored to address or augment current research paradigms. The interdisciplinary nature of psychophysics..÷like nursing..÷provides a unique lens for understanding how our perceptions are influenced by measurable sensations. While the quest to understand human perception is far from complete, nursing science has an opportunity to contribute to pain research by using the techniques and methods available through psychophysical procedures.
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Affiliation(s)
- Aaron L McDaniel
- From The Ohio State University College of Nursing, Columbus, Ohio.
| | | | - Stephen P Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd B Monroe
- From The Ohio State University College of Nursing, Columbus, Ohio
| | | | - Ronald L Cowan
- Department of Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Claire Ryan
- Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Davoudi M, Heydari A, Manzari ZS. Psychosocial Interventions by Nurses for Patients with HIV/ AIDS: A Systematic Review. J Caring Sci 2023; 12:94-102. [PMID: 37469749 PMCID: PMC10352634 DOI: 10.34172/jcs.2023.30726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 07/21/2023] Open
Abstract
Introduction Providing psychological support is one of the traditional roles of nurses for patients with HIV/AIDS. Searching the literature showed that various psychological interventions have been performed by nurses to support HIV/AIDS patients; however, no summary of these interventions is available. We aimed to systematically review the interventional studies which investigated the effectiveness of psychosocial interventions delivered by nurses to HIV/AIDS patients. Methods This systematic review was performed based on Cochrane's handbook of systematic reviews of interventional studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were used in this study. The databases of PubMed, Web of Science, Cochrane, Scopus and World Health Organization were searched from January 2009 to December 2022. Based on inclusion criteria, nine studies included in this systematic review. Cochrane data extraction form was used for the systematic review and the article's information was summarized using the modified Jadad scale. Results The interventions provided by the nurses included: virtual and face-to-face educational programs, written information resources, palliative care, motivational interview, case management, home visit, and care services, along with face-to-face and telephone follow-up. These interventions have a significant positive effect on the quality of life and management of high-risk behaviors, disease management, symptoms and complications, adherence to treatment, immune function, and mental health in patients with HIV/AIDS. Conclusion The results of the present study show that despite the fact that the interventions have a purely psychological content and can be done with various methods, they are able to have positive consequences in physical, psychological, behavioral, and laboratory health in HIV/AIDS patients.
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Affiliation(s)
- Malihe Davoudi
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Şentürk İA, Aşkın Turan S, Eyigürbüz T, Şentürk E, Kale İçen N. Pain-Related Cognitive Processes, Pain Interference, and Alexithymia in Patients With Primary Headaches. Cureus 2023; 15:e39688. [PMID: 37398774 PMCID: PMC10309013 DOI: 10.7759/cureus.39688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives This study aims to investigate the effects of pain-related cognitive processes (PRCPs) and emotional state on pain-related disability (PRD) and pain interference (difficulty in performing daily routines, difficulty in engaging in social activities [the enjoyment of life], and the impact on work and/or school performance) in patients with primary headaches (PHs). Methodology PRCPs were evaluated with the Pain Anxiety Symptom Scale-20 (PASS-20), Pain Catastrophizing Scale (PCS), and Pain Belief Questionnaire (PBQ). Anxiety, depression, and alexithymia were investigated to assess the emotional state. PRD was assessed by Headache Impact Test-6 (HIT-6). Health-related quality of life (HRQoL) was evaluated under three headings: daily activities (with Short Form-36 [SF-36] Question [Q] 22), social activities (with Graded Chronic Pain Scale-Revised [GCPS-R] Q 4), as well as the working ability (with GCPS-R Q 5). Two separate models were constructed to identify the factors influencing PRD and HRQoL in PHP: M1 to reveal the factors affecting PRD and M2 to determine the independent factors affecting pain interference. In both models, correlation analysis was applied first and the significant data were then evaluated with regression analysis. Results A total of 364 participants (74 healthy controls [HCs] and 290 PHPs) completed the study. In M1, the following domains were significantly associated with PRD: cognitive anxiety (β = 0.098; 95% confidence interval [CI] = 0.001-0.405; P = 0.049); helplessness (β = 0.107; 95% CI = 0.018-0.356; P = 0.031); alexithymia (β = 0.077; 95% CI = 0.005-0.116; P = 0.033); depression (β = 0.083; 95% CI = 0.014-0.011; P = 0.025). In M2, factors associated with impairment in daily activities for PHP were as follows: duration of pain, pain intensity, alexithymia, escape-avoidance response, psychological anxiety, anxiety, and poor sleep quality (R = 0.770; R2 = 0.588). The independent factors affecting social activities for PHP were pain intensity and pain-related anxiety (R = 0.90; R2 = 0.81). Independent risk factors that affected the ability to work for PHP were pain intensity, cognitive anxiety, escape-avoidance response, and pain anxiety (R = 0.90; R2 = 0.81). Conclusions This study highlights the importance of cognitive and emotional processes that help increase our understanding of the patient with PHs. This understanding may help to reduce disability and improve the quality of life in this population by helping to guide multidisciplinary treatment goals.
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Affiliation(s)
| | - Suna Aşkın Turan
- Pain Management, Mersin City Education and Research Hospital, Mersin, TUR
| | - Tuğba Eyigürbüz
- Neurology, Bağcılar Education and Research Hospital, İstanbul, TUR
| | - Erman Şentürk
- Psychiatry, NP Feneryolu Medical Center, Üsküdar University, İstanbul, TUR
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18
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Eaton LH, Flynn DM, Steffen AD, Doorenbos AZ. The Role of Psychological Factors in Chronic Pain Treatment Outcomes in the Military. Pain Manag Nurs 2023; 24:123-129. [PMID: 36653221 PMCID: PMC10106383 DOI: 10.1016/j.pmn.2022.12.007] [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: 09/08/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Chronic pain treatment in the military includes complementary and integrative health (CIH) therapies that may affect psychological factors such as pain catastrophizing, chronic pain acceptance, pain self-efficacy, and patient activation. The unique roles that psychosocial factors play in how CIH approaches reduce pain are not clear. This study examined if a holistic pain management program improved pain outcomes through psychological mediators in service members with chronic pain. DESIGN Secondary analysis of a clinical trial. METHODS Active-duty service members (n = 210) were randomly assigned to a 3-week course of standard rehabilitative care or standard rehabilitative care combined with CIH therapies. Both treatments were followed by a 3-week functional restoration program. Study measures were completed pre- and post-treatment using the Military Health System's Pain Assessment Screening Tool and Outcomes Registry. Mediation analyses tested the indirect effects of the change in psychological factors before functional restoration on the change in pain impact (e.g., pain intensity, pain interference, functional status) after functional restoration. RESULTS All psychological factors except for chronic pain acceptance were related to improved pain impact (p<.05). Furthermore, a change in psychological factors prior to functional restoration was related to the change in pain impact after functional restoration. However, the addition of CIH therapies to standard rehabilitative care did not result in changes in pain outcomes mediated by the psychological factors. CONCLUSIONS Although psychological factors were related to pain outcomes, the effect of CIH therapies on chronic pain did not occur via a change in the four psychological factors.
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Affiliation(s)
- Linda H Eaton
- University of Washington Bothell, School of Nursing and Health Studies, Bothell, Washington
| | - Diane M Flynn
- Interdisciplinary Pain Management Center, Madigan Army Medical Center, Tacoma, Washington.
| | - Alana D Steffen
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois.
| | - Ardith Z Doorenbos
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois; University of Washington, Anesthesiology and Pain Medicine, Seattle, Washington.
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Beas R, Riva-Moscoso A, Ribaudo I, Chambergo-Michilot D, Norwood DA, Karkash A, Izquierdo-Veraza D, Montrose J, Ramirez-Rojas M, Montalvan-Sanchez E. Prevalence of depression among patients with Chronic Pancreatitis: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2023; 47:102115. [PMID: 36977457 DOI: 10.1016/j.clinre.2023.102115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Chronic Pancreatitis (CP) is a fibroinflammatory condition with debilitating symptoms. Quality of life is severely affected in patients with CP and they are likely to suffer from mental health disorders, including depression. We conducted a systematic review and meta-analysis assessing the prevalence of depressive symptoms and depression in patients with CP. METHODS MEDLINE (OVID), PsycINFO, Cochrane Library, Embase, CINAHL Complete, Scopus and Web of Science were searched until July 2022 to identify manuscripts reporting the prevalence of depressive symptoms and depression (diagnosed clinically or with a validated scale without language restriction) in patients with Chronic Pancreatitis. The pooled prevalence was calculated using a random effects model. Heterogeneity was assessed by the inconsistency index (I2). RESULTS Among 3647 articles identified, 58 studies were identified for full text review, and ultimately nine studies were included. A total of 87136 patients were included in the studies. Depression was diagnosed clinically or symptoms were identified using validated scales including Center for Epidemiological Studies 10-item Depression Scale (CESD), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). The overall prevalence of depression in patients with chronic pancreatitis was 36.2% (95%CI: 18.8-55.7). In the stratified analysis, depression prevalence according to the clinical diagnosis, BDI and HADS was 30.10%, 48.17% and 36.61%, respectively. CONCLUSION The high prevalence of depression among patients with CP deserves a call-to-action due to its medical implications and worsening quality of life. Our findings raise awareness of the importance of screening patients with CP for mental health disorders. Further well-designed studies are needed to further characterize these findings.
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Affiliation(s)
- Renato Beas
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA..
| | - Adrian Riva-Moscoso
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Investigación y Docencia, Clínica Internacional, Lima, Peru
| | - Isabella Ribaudo
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Dalton Argean Norwood
- Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham
| | - Ahmad Karkash
- Oncology Department, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Diego Izquierdo-Veraza
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Montrose
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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20
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Schemer L, Hess CW, Van Orden AR, Birnie KA, Harrison LE, Glombiewski JA, Simons LE. Enhancing Exposure Treatment for Youths With Chronic Pain: Co-design and Qualitative Approach. J Particip Med 2023; 15:e41292. [PMID: 36892929 PMCID: PMC10037174 DOI: 10.2196/41292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Increasing the access to and improving the impact of pain treatments is of utmost importance, especially among youths with chronic pain. The engagement of patients as research partners (in contrast to research participants) provides valuable expertise to collaboratively improve treatment delivery. OBJECTIVE This study looked at a multidisciplinary exposure treatment for youths with chronic pain through the lens of patients and caregivers with the aim to explore and validate treatment change processes, prioritize and develop ideas for improvement, and identify particularly helpful treatment elements. METHODS Qualitative exit interviews were conducted with patients and caregivers at their discharge from 2 clinical trials (ClinicalTrials.gov NCT01974791 and NCT03699007). Six independent co-design meetings were held with patients and caregivers as research partners to establish a consensus within and between groups. The results were validated in a wrap-up meeting. RESULTS Patients and caregivers described that exposure treatment helped them better process pain-related emotions, feel empowered, and improve their relationship with each other. The research partners developed and agreed upon 12 ideas for improvement. Major recommendations include that pain exposure treatment should be disseminated more not only among patients and caregivers but also among primary care providers and the general public to facilitate an early referral for treatment. Exposure treatment should allow flexibility in terms of duration, frequency, and delivery mode. The research partners prioritized 13 helpful treatment elements. Most of the research partners agreed that future exposure treatments should continue to empower patients to choose meaningful exposure activities, break long-term goals into smaller steps, and discuss realistic expectations at discharge. CONCLUSIONS The results of this study have the potential to contribute to the refinement of pain treatments more broadly. At their core, they suggest that pain treatments should be disseminated more, flexible, and transparent.
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Affiliation(s)
- Lea Schemer
- Department of Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Courtney W Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Amanda R Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Department of Community Health Sciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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21
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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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22
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Ferreira-Valente A, Van Dyke BP, Day MA, Teotónio do Carmo C, Pais-Ribeiro J, Pimenta F, Costa RM, Jensen MP. Immediate Effects of Hypnosis, Mindfulness Meditation, and Prayer on Cold Pressor Outcomes: A Four-Arm Parallel Experimental Study. J Pain Res 2022; 15:4077-4096. [PMID: 36582659 PMCID: PMC9793782 DOI: 10.2147/jpr.s388082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose Previous research supports the usefulness of hypnosis (HYP), mindfulness meditation (MM), and prayer as pain self-management strategies in adults with chronic pain. However, their effects on acute pain have been less researched, and no previous head-to-head study compared the immediate effects of these three approaches on pain-related outcomes. This study compared the immediate effects of HYP, MM, and Christian prayer (CP) on pain intensity, pain tolerance, and stress as assessed by heart rate variability (HRV). Participants and Methods A total of 232 healthy adults were randomly assigned to, and completed, a single 20-minute session of MM, SH, CP, or an attention control (CN), and underwent two cycles (one pre- and one post-intervention) of Cold Pressor Arm Wrap (CPAW). Sessions were audio-delivered. Participants responded to pre- and post-intervention pain intensity measurements. Pain tolerance (sec) was assessed during the CPAW cycles. HRV was assessed at baseline, and at pre- and post-intervention CPAW cycles. The study protocol was pre-registered at the ClinicalTrials.gov registry (NCT04491630). Results Small within-group decreases in pain intensity and small increases in pain tolerance were found for HYP and MM from the pre- to the post-intervention. Small within-group improvements in the LH/HF ratio were also found for HYP. The exploratory between-group pairwise comparisons revealed a medium effect size effects of HYP on pain tolerance relative to the control condition. The effects of CP were positive, but small and not statistically significant. Only small to medium, though non-significant, Time × Group interaction effects were found. Conclusion Study results suggest that single short-term HYP and MM sessions, but not biblical-based CP, may be useful for acute pain self-management, with HYP being the slightly superior option. Future research should compare the effects of different types of prayer and examine the predictors and moderators of these pain approaches' effects on pain-related outcomes.
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Affiliation(s)
- Alexandra Ferreira-Valente
- William James Center for Research, Ispa – University Institute, Lisbon, Portugal,Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA,Research Center for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, Porto, Portugal,Correspondence: Alexandra Ferreira-Valente, Research Center for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, Rua de Diogo Botelho, Porto, 1327 4169-005, Portugal, Tel +351 226196200, Email
| | | | - Melissa A Day
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA,School of Psychology, Faculty of Health & Behavioral Sciences, University of Queensland, Brisbane, Australia
| | | | - José Pais-Ribeiro
- William James Center for Research, Ispa – University Institute, Lisbon, Portugal
| | - Filipa Pimenta
- William James Center for Research, Ispa – University Institute, Lisbon, Portugal
| | - Rui M Costa
- William James Center for Research, Ispa – University Institute, Lisbon, Portugal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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23
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The biopsychosocial model of pain 40 years on: time for a reappraisal? Pain 2022; 163:S3-S14. [DOI: 10.1097/j.pain.0000000000002654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
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24
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Bhattarai M, Smedema SM, Hoyt WT, Bishop M. The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study. Health Qual Life Outcomes 2022; 20:148. [PMID: 36310168 PMCID: PMC9620601 DOI: 10.1186/s12955-022-02059-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Quality of life is considered the most overarching psychosocial adaptation outcome following the rehabilitation of persons with spinal cord injury. Literature suggests that the quality of life of persons with spinal cord injury is determined by many personal and psychological factors, including mindfulness. This study aimed to identify the direct and indirect effect of mindfulness on the quality of life of persons living with spinal cord injury. METHODS Participants consisted of 231 members of three spinal cord injury organizations in the United States: United Spinal Association, North American Spinal Cord Injury Consortium, and Paralyzed Veterans of America-Wisconsin Chapter. The participants completed a set of standardized self-report questionnaires in an online Qualtrics survey. A hierarchical regression analysis was performed to identify the contribution of mindfulness to quality of life, controlling for sociodemographic and injury-related factors. A serial mediation analysis was performed to examine the indirect effect of mindfulness on quality of life. RESULTS In the hierarchical regression analysis, sociodemographic and injury-related factors (i.e., age, gender, race, marital status, education, employment, level and completeness of injury, comorbidities, frequency of hospitalization, pain intensity, and functional limitation) and mindfulness explained 59% variance on quality of life of the participants with spinal cord injury. Mindfulness uniquely contributed to the higher quality of life above and beyond sociodemographic and injury-related variables. In the serial mediation analysis, pain and functional limitation did not significantly mediate the relationship between mindfulness and quality of life. However, the indirect effects of mindfulness on functional limitation and quality of life through pain were significant. CONCLUSION The findings underscore the vital role of mindfulness in improving the quality of life of persons with spinal cord injury. Implications of these findings for future research and clinical practice are discussed.
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Affiliation(s)
- Muna Bhattarai
- grid.264756.40000 0004 4687 2082School of Nursing, Texas A&M University, 8447 Riverside Pkwy, 77807-3260 Bryan, TX USA
| | - Susan Miller Smedema
- grid.14003.360000 0001 2167 3675Department of Rehabilitation Psychology & Special Education, University of Wisconsin–Madison, Madison, WI USA
| | - William T. Hoyt
- grid.14003.360000 0001 2167 3675Department of Counseling Psychology, University of Wisconsin–Madison, Madison, WI USA
| | - Malachy Bishop
- grid.14003.360000 0001 2167 3675Department of Rehabilitation Psychology & Special Education, University of Wisconsin–Madison, Madison, WI USA
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25
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Fonia D, Aisenberg D. The Effects of Mindfulness Interventions on Fibromyalgia in Adults aged 65 and Older: A Window to Effective Therapy. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09911-7. [PMID: 36163446 DOI: 10.1007/s10880-022-09911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
Pain usually receives insufficient attention by individuals due to the misconception that pain is a natural consequence of aging. For persons aged 65 and older, a disease requiring further research is fibromyalgia, characterized by chronic pain without clear pathology. Mind-body therapies like mindfulness are beneficial for this population as they affect psychological and biological aspects of pain. These therapies emphasize a nonjudgmental acceptance of thoughts and attention to the experience without attempting to resist or change them. Despite the potential benefits of mindfulness interventions for persons with fibromyalgia aged 65 and older, only few studies have examined the effects of these therapies, yielding conflicting findings. Importantly, no study has yet to be conducted exclusively on this population. This comprehensive review examined existing literature focusing on the effects of mindfulness-based interventions on the physical and mental well-being of persons with fibromyalgia aged 65 and older. It highlights the need for further research on the relationship between mindfulness, fibromyalgia, and gerontology, calling for a standard protocol of intervention.
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Affiliation(s)
- Dvir Fonia
- Clinical Psychology of Adulthood and Aging, Ruppin Academic Center, Emek Hefer, Israel.
| | - Daniela Aisenberg
- Clinical Psychology of Adulthood and Aging, Ruppin Academic Center, Emek Hefer, Israel
- The Dror (Imri) Aloni Center for Health Informatics, Ruppin Academic Center, Emek Hefer, Israel
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26
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Pulling BW, Braithwaite FA, Moseley GL, Jensen MP, Burke ALJ, Collins KL, Hull MJ, Jones HG, Cyna AM, Ferencz N, Stanton TR. Suggestions in Hypnosis to Aid Pain Education (SHAPE) in People with Chronic Low-Back Pain: A Pilot Feasibility Randomized, Controlled Trial. Int J Clin Exp Hypn 2022; 70:251-276. [PMID: 35969169 DOI: 10.1080/00207144.2022.2105147] [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] [Indexed: 11/05/2022]
Abstract
Chronic low back pain (CLBP) is a debilitating and burdensome condition, and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants. A priori feasibility and intervention acceptability criteria were set. Twenty participants with CLBP were recruited and randomized to receive: (1) hypnotically delivered pain science education that utilizes hypnotic suggestions to enhance uptake of pain science concepts; or (2) pain science education with progressive muscle relaxation as an attention control. Twenty participants were recruited, however, not solely from the hospital waitlist as intended; community sampling was required (13 hospital, 7 community). Most criteria were met in the community sample but not the hospital sample. Protocol modifications are needed before progressing to a full scale randomized controlled trial for hypnotically reinforced pain science education. Improvements in relevant secondary outcomes paired with moderate-high treatment acceptability ratings are promising.
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Affiliation(s)
- Brian W Pulling
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - Felicity A Braithwaite
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Anne L J Burke
- Psychology Department, Central Adelaide Local Health Network, South Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Kathryn L Collins
- Psychology Department, Central Adelaide Local Health Network, South Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | - Melissa J Hull
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide
| | - Hannah G Jones
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide.,Institute of Psychiatry, Psychology & Neuroscience, Kings College London, England, United Kingdom
| | - Allan M Cyna
- Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia
| | - Nicki Ferencz
- Paediatric Chronic Pain Service, Women's and Children's Hospital, Adelaide, South Australia
| | - Tasha R Stanton
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide
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27
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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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28
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Nøst TH, Woodhouse A, Dale LO, Hara KW, Steinsbekk A. Participants' experiences from group-based treatment at multidisciplinary pain centres - a qualitative study. Scand J Pain 2022; 22:365-373. [PMID: 34453878 DOI: 10.1515/sjpain-2021-0099] [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: 06/03/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to explore the experiences of participants in non-pharmacological group-based treatments delivered as part of a randomised controlled trial at Norwegian tertiary care pain centres. METHODS Individual semi-structured interviews with 15 persons were conducted. The data were analysed with a descriptive thematic cross-case analysis based on the method of systematic text condensation. RESULTS All participants talked about some aspects of the group-based treatments as a positive experience, but mainly the outcome was in line with their expectations; they hoped it would reduce their pain but did not expect it. There were no clear-cut differences in the experiences between the participants from the two different intervention groups. The content was experienced as both relevant and interesting but also to introduce concepts that were difficult to grasp and understand. Similarly, the experiences of participating in a group-based treatment were mostly stimulating but could also be challenging because of an expectancy of sharing personal stories. Although experiencing few changes to their pain they came away with techniques and lessons that were valuable to them. CONCLUSIONS In this study, taking part in group-based treatment was perceived as giving positive and valuable lessons, due to relevant content and learning from the professionals and fellow participants, but without any clear indication of reduced pain. Approval from ethical committee number 10260 REK Midt. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04057144.
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Affiliation(s)
- Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Astrid Woodhouse
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars-Oskar Dale
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Karen Walseth Hara
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Digital health care unit, Norwegian Centre for E-Health Research, Tromsø, Norway
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29
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Abushukur Y, Cascardo C, Ibrahim Y, Teklehaimanot F, Knackstedt R. Improving Breast Surgery Outcomes Through Alternative Therapy: A Systematic Review. Cureus 2022; 14:e23443. [PMID: 35481320 PMCID: PMC9034658 DOI: 10.7759/cureus.23443] [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] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols are the current standard of care when it comes to improving post-surgical outcomes in breast cancer patients. Compliance with all protocol items is required in order for patients to experience significant benefits. Given that the ERAS protocols involve numerous medications which each have unique side effect profiles and medication interactions, this is often difficult to accomplish. Additionally, breast cancer patients are often left with a large psychological burden, which ERAS protocols fail to address. This review aims to determine the role that alternative therapies can play in improving both the emotional and physical strains patients experience during the post-operative stage of recovery. A PubMed search was conducted using the following search terms (“alternative medicine” or “complementary medicine” or “integrative medicine” or “holistic medicine” or “natural medicine" or “mediation” or “aromatherapy” or “music” or “art” or “reiki” or “massage”) and (“surgery”) and (“pain”). Studies selected for this review include articles published or translated in English that addressed alternative medical interventions affecting pre-, peri-, or post-operative outcomes in breast biopsies, surgeries, or breast-related procedures. Eighteen articles fit the inclusion criteria, with seven addressing music, five addressing meditation, yoga, and guided imagery, five addressing massage, one addressing myofascial release, four addressing aromatherapy, two addressing acupuncture, and three addressing hypnosis. Most forms of alternative therapies offered some benefit to patients following breast-related procedures, many resulting in improvements in post-operative outcomes including pain, fatigue, energy, stress, anxiety, mood, and depression. The reviewed studies demonstrated numerous benefits to integrating alternative medicine into standardized therapy to improve postoperative outcomes. Most studies analyzed did not include placebo controls as including proper placebos was often not feasible. Future studies with larger sample sizes are needed to better quantify the benefits patients receive from these noninvasive, low-risk complementary therapies.
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30
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Geagea D, Griffin B, Kimble R, Polito V, Terhune DB, Tyack Z. Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol. Pilot Feasibility Stud 2022; 8:58. [PMID: 35264248 PMCID: PMC8905723 DOI: 10.1186/s40814-022-01017-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. Methods An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. Discussion Ethical approval was obtained from the Queensland Children’s Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings. The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000988954 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01017-z.
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Affiliation(s)
- Dali Geagea
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4058, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4058, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Vince Polito
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Devin B Terhune
- Department of Psychology, Goldsmiths University of London, London, SE14 6NW, UK
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.,Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
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31
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Peat G, Jordan KP, Wilkie R, Corp N, van der Windt DA, Yu D, Narle G, Ali N. Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness. J Public Health (Oxf) 2022; 44:e376-e387. [PMID: 35257184 PMCID: PMC9424108 DOI: 10.1093/pubmed/fdac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background It is unclear whether seven interventions recommended by Public Health England for preventing and managing common musculoskeletal conditions reduce or widen health inequalities in adults with musculoskeletal conditions. Methods We used citation searches of Web of Science (date of ‘parent publication’ for each intervention to April 2021) to identify original research articles reporting subgroup or moderator analyses of intervention effects by social stratifiers defined using the PROGRESS-Plus frameworks. Randomized controlled trials, controlled before-after studies, interrupted time series, systematic reviews presenting subgroup/stratified analyses or meta-regressions, individual participant data meta-analyses and modelling studies were eligible. Two reviewers independently assessed the credibility of effect moderation claims using Instrument to assess the Credibility of Effect Moderation Analyses. A narrative approach to synthesis was used (PROSPERO registration number: CRD42019140018). Results Of 1480 potentially relevant studies, seven eligible analyses of single trials and five meta-analyses were included. Among these, we found eight claims of potential differential effectiveness according to social characteristics, but none that were judged to have high credibility. Conclusions In the absence of highly credible evidence of differential effectiveness in different social groups, and given ongoing national implementation, equity concerns may be best served by investing in monitoring and action aimed at ensuring fair access to these interventions.
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Affiliation(s)
- G Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - K P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - R Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - N Corp
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D A van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - G Narle
- Public Health England, London, SE1 8UG, UK.,Versus Arthritis, Chesterfield, S41 7TD, UK
| | - N Ali
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, SW1H 0EU, UK
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Yadav D, Palermo TM, Phillips AE, Bellin MD, Conwell DL. Painful chronic pancreatitis - new approaches for evaluation and management. Curr Opin Gastroenterol 2021; 37:504-511. [PMID: 34172622 PMCID: PMC8826115 DOI: 10.1097/mog.0000000000000769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis. RECENT FINDINGS Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy. SUMMARY Several lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
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Affiliation(s)
- Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Anna E. Phillips
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Melena D. Bellin
- Division of Endocrinology and Metabolism, University of Minnesota Medical Center, Minneapolis, MN
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
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Jensen MP, Hakimian S, Ehde DM, Day MA, Pettet MW, Yoshino A, Ciol MA. Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions. Pain 2021; 162:2036-2050. [PMID: 33470745 PMCID: PMC8205936 DOI: 10.1097/j.pain.0000000000002201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
ABSTRACT The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Shahin Hakimian
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Melissa A Day
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Mark W Pettet
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Hiroshima University, Higashihiroshima, Japan
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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Cognitive Defusion Is a Core Cognitive Mechanism for the Sensory-Affective Uncoupling of Pain During Mindfulness Meditation. Psychosom Med 2021; 83:566-578. [PMID: 33790200 DOI: 10.1097/psy.0000000000000938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Mindfulness meditation can downregulate the experience of pain. However, its specific underlying regulatory mechanisms are still largely unknown. Here, we aimed to investigate the role of cognitive defusion-a form of psychological distancing from internal experiences-in mindfulness-based pain regulation. METHODS We implemented a thermal heat paradigm that was designed to amplify the cognitive-affective aspects of pain in 43 novice meditators (2-day formal training; 51.2% women; 53.2 ± 7.0 years old) and 27 expert meditators (>10,000-hour practice; 44.4% women; 51.9 ± 8.4 years old). We collected pain intensity and unpleasantness reports and trait measures of pain catastrophizing assessed by the Pain Catastrophizing Scale (PCS), cognitive defusion assessed by the Drexel Defusion Scale (DDS), and cognitive fusion assessed by the Cognitive Fusion Questionnaire, as well as of several other constructs commonly reported in the literature. RESULTS Experts reported lower PCS (6.9 ± 5.2 versus 17.2 ± 8.5, p < .001) but higher DDS (39.4 ± 6.4 versus 28.9 ± 6.6, p < .001) than novices. Across participants, the PCS and DDS were negatively correlated and shared unique variance that survived adjusting for other mindfulness-related and cognitive-emotional constructs (β = -0.64, p < .001). Conversely, the relationships between PCS and other commonly reported constructs did not seem specific, as none of the relationships survived adjusting for DDS (adjusted β < 0.25, p > .05). Further supporting the relevance of DDS to pain, both the DDS and PCS specifically predicted pain unpleasantness as opposed to pain intensity. However, DDS seemed to be a more specific predictor of unpleasantness than PCS, as the relationship between DDS and unpleasantness survived adjusting for PCS (adjusted β = -0.33, p = .016), but not vice versa (adjusted β = 0.20, p = .162). We also found that the Cognitive Fusion Questionnaire showed a similar pattern of associations with PCS and pain self-reports to what was found for the DDS, although these associations were less consistent. CONCLUSIONS Collectively, these findings highlight the central role of cognitive defusion in mindfulness-based pain regulation.
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Ferreira-Valente A, Pimenta F, Costa RM, Day MA, Pais-Ribeiro J, Jensen MP. COPAHS Study: protocol of a randomised experimental study comparing the effects of hypnosis, mindfulness meditation, and spiritual practices on experimental pain in healthy adults. BMJ Open 2021; 11:e040068. [PMID: 33558346 PMCID: PMC7871695 DOI: 10.1136/bmjopen-2020-040068] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/06/2020] [Revised: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There has been an increasing interest in studying the potential benefits of so-called complementary and alternative approaches for pain management, such as hypnosis and mindfulness-based interventions. More recently, researchers have been interested in studying the effects of spiritual practices on pain experience as well. These practices may increase pain tolerance, result in a positive re-appraisal of pain and influence other psychological variables that are known to be associated with pain experience. The purpose of this study is to evaluate and compare the immediate effects of self-hypnosis, mindfulness meditation, and a spiritual intervention relative to a control condition for increasing pain tolerance and reducing pain intensity and pain-related stress, in response to experimental painful stimulation. METHODS AND ANALYSIS Recruitment is anticipated to start in November 2020. This is a randomised quantitative experimental mixed-design repeated-measures study with three assessment points: baseline (T0), pre-test (T1) and post-test (T2). Eligible healthy adults will be randomised to one of the four study conditions. Interventions will be a 20-minute audio-guided practice of either self-hypnosis, mindfulness meditation, or Christian prayer. Participants in the control group will not be instructed to use any specific strategy during the painful stimulation. Participants will be submitted to a first cycle of Cold Pressor Arm Wrap. They will then listen to a 20-minute audio recording inducing one of the three interventions, or, in the case of the control group, to a 20-minute audio recording of text from a natural history textbook. Primary outcomes are pain intensity and pain tolerance. Pain-related stress as measured by salivary cortisol level and heart rate variability are secondary outcomes. ETHICS AND DISSEMINATION This study was approved by ISPA-University Institute's internal Ethics Committee for Research on 3rd December 2018 (reference I/010/12/2018). Findings will be published in peer-reviewed indexed journals and presented at conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry (NCT04491630). Stage: pre-results.
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Affiliation(s)
- Alexandra Ferreira-Valente
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Filipa Pimenta
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
| | - Rui M Costa
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
| | - Melissa A Day
- The University of Queensland, School of Psychology, Saint Lucia, Queensland, Australia
| | - José Pais-Ribeiro
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Coronado RA, Ehde DM, Pennings JS, Vanston SW, Koyama T, Phillips SE, Mathis SL, McGirt MJ, Spengler DM, Aaronson OS, Cheng JS, Devin CJ, Wegener ST, Archer KR. Psychosocial Mechanisms of Cognitive-Behavioral-Based Physical Therapy Outcomes After Spine Surgery: Preliminary Findings From Mediation Analyses. Phys Ther 2020; 100:1793-1804. [PMID: 32556249 PMCID: PMC7530577 DOI: 10.1093/ptj/pzaa112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 04/22/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Changing Behavior through Physical Therapy (CBPT), a cognitive-behavioral-based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery. METHODS In this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n = 43) and education program (n = 43). Participants completed validated questionnaires at 6 weeks (baseline) and 3 and 6 months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6 months. RESULTS Six-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6 months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect = -2.0 [95% CI = -4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect = 3.5 [95% CI = 1.2 to 6.1]). CONCLUSIONS This study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism. IMPACT Fear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs.
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Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Department of Physical Medicine and Rehabilitation, and Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, and Center for Musculoskeletal Research, Vanderbilt University Medical Center
| | - Susan W Vanston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center
| | | | - Shannon L Mathis
- Department of Kinesiology, University of Alabama, Huntsville, Alabama
| | - Matthew J McGirt
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Dan M Spengler
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Oran S Aaronson
- Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, Tennessee
| | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center; and Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland
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Day MA, Ehde DM, Burns J, Ward LC, Friedly JL, Thorn BE, Ciol MA, Mendoza E, Chan JF, Battalio S, Borckardt J, Jensen MP. A randomized trial to examine the mechanisms of cognitive, behavioral and mindfulness-based psychosocial treatments for chronic pain: Study protocol. Contemp Clin Trials 2020; 93:106000. [PMID: 32302791 PMCID: PMC7195020 DOI: 10.1016/j.cct.2020.106000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
This randomized trial will evaluate the mechanisms of three chronic pain treatments: cognitive therapy (CT), mindfulness meditation (MM), and activation skills (AS). We will determine the extent to which late-treatment improvement in primary outcome (pain interference) is predicted by early-treatment changes in cognitive content, cognitive process, and/or activity level. The shared versus specific role of these mechanisms across the three treatments will be evaluated during treatment (Primary Aim), and immediately post-treatment to examine relapse mechanisms (Secondary Aim). We will enroll 300 individuals with chronic pain (with low back pain as a primary or secondary condition), with 240 projected to complete the study. Participants will be randomly assigned to eight, 1.5 h telehealth group sessions of CT, MM, or AS. Mechanisms and outcomes will be assessed twice daily during 2-week baseline, 4-week treatment period, and 4-week post-treatment epoch via random cue-elicited ecological momentary assessment (EMA); activity level will be monitored during these time epochs via daily monitoring with ActiGraph technology. The primary outcome will be measured by the PROMIS 5-item Pain Interference scale. Structural equation modeling (SEM) will be used to test the primary aims. This study is pre-registered on clinicaltrials.gov (Identifier: NCT03687762). This study will determine the temporal sequence of lagged mediation effects to evaluate rates of change in outcome as a function of change in mediators. The findings will provide an empirical basis for enhancing and streamlining psychosocial chronic pain interventions. Further, results will guide future efforts towards optimizing maintenance of gains to effectively reduce relapse risk.
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Affiliation(s)
- M A Day
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia.
| | - D M Ehde
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J Burns
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - L C Ward
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J L Friedly
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - B E Thorn
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - M A Ciol
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - E Mendoza
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J F Chan
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - S Battalio
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J Borckardt
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - M P Jensen
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
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Vowles KE, Pielech M, Edwards KA, McEntee ML, Bailey RW. A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain. THE JOURNAL OF PAIN 2020; 21:529-545. [PMID: 31683020 PMCID: PMC7477894 DOI: 10.1016/j.jpain.2019.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/07/2019] [Accepted: 10/27/2019] [Indexed: 11/17/2022]
Abstract
While much of the literature provides positive support for psychological interventions for chronic pain, 2 recent meta-analyses indicate small to moderate benefits only. This inconsistency in findings suggests that there are other treatment-related variables to consider. One possible consideration pertains to treatment format, as psychological models form the basis for both unidisciplinary psychology and integrated interdisciplinary treatments for chronic pain. Therefore, a comparative meta-analysis of unidisciplinary and interdisciplinary treatments was performed to determine whether there were differences in treatment effect size (ES) at post-treatment and follow-ups of up to 1 year. One specific treatment model, Acceptance and Commitment Therapy (ACT), was investigated as it was felt that this literature was extensive enough to perform the planned analysis, while also being circumscribed enough in size to make it feasible. In total, 29 articles met inclusion criteria, 13 reported outcomes for unidisciplinary ACT, and 15 for interdisciplinary ACT. At both post-treatment and follow-up, interdisciplinary ACT had a greater ES for physical disability, psychosocial impact, and depression compared to unidisciplinary ACT. No differences in ES were observed for pain intensity, pain-related anxiety, or pain acceptance. Findings remained the same when study heterogeneity was considered. There was a significant difference observed between treatment format and treatment duration-on average, unidisciplinary interventions were of shorter duration than interdisciplinary interventions. Moderation analyses examining the relation between total treatment duration and ES generally indicated a moderate positive relation between treatment length and ES. This relation was strong for psychosocial impact. PERSPECTIVE: A comparative meta-analysis examined the relative ES of unidisciplinary (ie, clinical psychology only) and interdisciplinary ACT for chronic pain in 29 studies. The ES for interdisciplinary ACT was larger than unidisciplinary ACT for physical disability, psychosocial impact, and depression. No differences were present for pain intensity, anxiety, and acceptance.
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Affiliation(s)
- Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Melissa Pielech
- Center for Alcohol and Addictions Studies, Brown University, Providence, Rhode Island
| | - Karlyn A Edwards
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Mindy L McEntee
- College of Health Solutions, Arizona State University, Tempe, Arizona
| | - Robert W Bailey
- Swedish Pain Services, Swedish Health System, Seattle, Washington
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Day MA, Ward LC, Grover MP, Ehde DM, Illingworth OR, Jensen MP. The roles of race, sex and cognitions in response to experimental pain. Eur J Pain 2020; 24:1072-1083. [PMID: 32115805 DOI: 10.1002/ejp.1552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/24/2020] [Accepted: 02/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study reports a multivariate test of sex and race differences in experimental pain, and the degree to which these differences could be uniquely attributable to three levels of cognition: primary appraisals (threat, challenge), secondary appraisals (pain catastrophizing) and/or cognitive processes (mindful observing, non-reactivity). Both the predictive and mediator role of the cognitive variables was of interest. METHODS The study employed a cross-sectional experimental design, with the cold pressor task employed as the pain stimulus. The total sample included N = 355 healthy adults (67% female, 33% male; 70% Caucasian, 30% Asian). RESULTS Significant sex and race differences on pain tolerance were found, with females and racial minorities reporting less pain tolerance (ps < 0.001). Males reported significantly higher challenge appraisals and non-reactivity, and lower pain catastrophizing than females; Asians reported significantly higher threat appraisals and pain catastrophizing than Caucasians. In multivariate analyses, challenge appraisals and non-reactivity emerged as the strongest predictors of pain tolerance. Furthermore, challenge appraisals mediated the sex-pain tolerance association (p = .017). CONCLUSIONS This study showed that race and sex differences, at least in part, may be accounted for by differences in pain-related cognitions. SIGNIFICANCE The three levels of cognition investigated in this research represent changeable, important processes for potentially mitigating the impact of pain in vulnerable groups.
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Affiliation(s)
- Melissa A Day
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Department of Rehabilitation Medicine, The University of Washington, Seattle, WA, USA
| | - L Charles Ward
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Michelle P Grover
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, The University of Washington, Seattle, WA, USA
| | - Oliver R Illingworth
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, The University of Washington, Seattle, WA, USA
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Williams RM, Ehde DM, Day M, Turner AP, Hakimian S, Gertz K, Ciol M, McCall A, Kincaid C, Pettet MW, Patterson D, Suri P, Jensen MP. The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans. Contemp Clin Trials 2020; 90:105935. [PMID: 31926321 PMCID: PMC7072005 DOI: 10.1016/j.cct.2020.105935] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions. METHODS Participants will include up to 343 Veterans with chronic pain due to a broad range of etiologies, randomly assigned to one of three 8-week manualized in-person group treatments: (1) Hypnosis (HYP), (2) Mindfulness Meditation (MM), or (3) Education Control (EDU). PROJECTED OUTCOMES The primary aim of the study is to compare the effectiveness of HYP and MM to EDU on average pain intensity measured pre- and post-treatment. Additional study aims will explore the effectiveness of HYP and MM compared to EDU on secondary outcomes (i.e., pain interference, sleep, depression, anxiety and PTSD), and the maintenance of effects at 3- and 6-months post-treatment. Participants will have electroencephalogram (EEG) assessments at pre- and post-treatment to determine if the power of specific brain oscillations moderate the effectiveness of HYP and MM (Study Aim 2) and examine brain oscillations as possible mediators of treatment effects (exploratory aim). Additional planned exploratory analyses will be performed to identify possible treatment mediators (i.e., pain acceptance, catastrophizing, mindfulness) and moderators (e.g., hypnotizability, treatment expectations, pain type, cognitive function). SETTING The study treatments will be administered at a large Veterans Affairs Medical Center in the northwest United States. The treatments will be integrated within clinical infrastructure and delivered by licensed and credentialed health care professionals.
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Affiliation(s)
- Rhonda M Williams
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America; University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America.
| | - Dawn M Ehde
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Melissa Day
- The University of Queensland, School of Psychology, Faculty of Health & Behavioral Sciences, St. Lucia Campus, Brisbane, QLD 4072, Australia
| | - Aaron P Turner
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America; University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Shahin Hakimian
- University of Washington School of Medicine, Department of Neurology, Harborview Medical Center, 325 Ninth Ave, Box 359745, Seattle, WA 98104, United States of America
| | - Kevin Gertz
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Marcia Ciol
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Alisha McCall
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America
| | - Carrie Kincaid
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America
| | - Mark W Pettet
- University of Washington, Integrated Brain Imaging Center, Department of Radiology, 1959 NE Pacific St., Box 357115, Seattle, WA 98195, United States of America
| | - David Patterson
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Pradeep Suri
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America; University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Mark P Jensen
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
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Namjoo S, Borjali A, Seirafi M, Assarzadegan F. Use of Mindfulness-based Cognitive Therapy to Change Pain-related Cognitive Processing in Patients with Primary Headache: A Randomized Trial with Attention Placebo Control Group. Anesth Pain Med 2020; 9:e91927. [PMID: 31903329 PMCID: PMC6925538 DOI: 10.5812/aapm.91927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/02/2019] [Accepted: 09/07/2019] [Indexed: 02/04/2023] Open
Abstract
Background Mindfulness-based interventions have shown to be efficient in managing chronic pain. Cognitive factors play a prominent role in chronic pain complications and negative cognitive contents about pain are often the first issues targeted in cognitive-based therapies, which are known as first-line treatment of chronic pain over the past decades. Little, however, is known about the manner of thinking about pain or pain-related cognitive processing. Objectives Therefore, the purpose of this study was to investigate the effect of mindfulness-based cognitive therapy (MBCT) on pain-related cognitive processing and control of chronic pain in patients with primary headache. Methods A clinical trial was conducted in 2017 - 2018 on 85 Persian language patients with one type of primary headache selected through purposive sampling in Emam Hossein Hospital in Tehran province. To measure the variables of the study, we used the Brief Pain Inventory (BPI) and Pain-related Cognitive Processing Questionnaire (PCPQ). All data were analyzed by independent t-test and chi-square and longitudinal data were analyzed using linear mixed model analysis. Results Statistically significant time × group interactions were found in pain intensity (P < 0.001), pain interference (P < 0.001), as well as in three cognitive processing subscales including pain focus, pain distancing, and pain openness (P < 0.001). However, the results of pain diversion were not meaningful. Conclusions MBCT is a potentially efficacious approach for individuals with headache pain. Regulation and correction of cognitive processing are considered as effective cognitive coping strategies in MBCT treatment.
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Affiliation(s)
- Sarah Namjoo
- Department of Health Psychology, Faculty of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
- Corresponding Author: Department of Health Psychology, Faculty of Psychology, Karaj Branch, Islamic Azad University, Rajaee Shahr Ave., Moazzen Blvd., Karaj, Alborz, Iran. Tel: +98-9124968116,
| | - Ahmad Borjali
- Department of Psychology, Allameh Tabataba’i University, Tehran, Iran
| | | | - Farhad Assarzadegan
- Department of Neurology, Shahid Beheshti University of Medical Science, Tehran, Iran
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Grinberg AS, Sellinger JJ, Sprenkle PC, Bandin AJ, Nawaf CB, Syed JS, Leapman MS. Effect of Diaphragmatic Breathing on Procedural Anxiety During Transrectal Prostate Biopsy. Urology 2019; 137:26-32. [PMID: 31893532 DOI: 10.1016/j.urology.2019.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/09/2019] [Accepted: 12/21/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To improve the tolerability of transrectal ultrasound guided prostate biopsy through use of diaphragmatic breathing. METHODS Forty-seven patients, aged 52-79 years, who were scheduled for a transrectal ultrasound guided prostate biopsy with or without MRI guidance, were recruited at a single Veterans Affairs medical center for the diagnosis or evaluation of prostate cancer. Patients either met with a health psychologist for a 1-time, diaphragmatic breathing intervention immediately prior to their biopsy, or received usual care. All biopsies were performed using local anesthetic without sedation or anxiolytic therapy. The primary outcome was the difference in self-reported procedural situational anxiety as measured with the State Trait Anxiety Inventory, assessed both pre- and post-transrectal ultrasound guided prostate biopsy. We also examined secondary outcomes including physiological parameters (heart rate and blood pressure). RESULTS There were no significant differences in preprocedural anxiety or physiological parameters between patients who received the intervention and those who received usual care. Patients who received the intervention had a significantly larger decrease in situational anxiety from pre- to postprocedure (M = 14.15, SD = 6.64) compared with those who received usual care (M = 3.45, SD = 9.97); t (38) = -4.0, P <.000; d = 1.26. Patients who received the intervention had a significantly larger decrease in heart rate (bpm) from pre- to postprocedure (M = 10.63, SD = 12.21) compared with those who received usual care (M = 0.07, SD = 9.25); t (31) = 2.75 P = 0.010; d = 0.97. CONCLUSION A guided diaphragmatic breathing intervention reduced procedural anxiety during prostate biopsy and improved patient experience.
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Affiliation(s)
- Amy S Grinberg
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT.
| | - John J Sellinger
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Preston C Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, CT; Urology Service, VA Connecticut Healthcare System, West Haven, CT
| | | | - Cayce B Nawaf
- Urology Service, VA Connecticut Healthcare System, West Haven, CT
| | - Jamil S Syed
- Urology Service, VA Connecticut Healthcare System, West Haven, CT
| | - Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT; Urology Service, VA Connecticut Healthcare System, West Haven, CT
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Zheng K, Wang X. Publications on the Association Between Cognitive Function and Pain from 2000 to 2018: A Bibliometric Analysis Using CiteSpace. Med Sci Monit 2019; 25:8940-8951. [PMID: 31762442 PMCID: PMC6894366 DOI: 10.12659/msm.917742] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aimed to use CiteSpace software to conduct a bibliometric analysis of published studies on the association between pain and cognitive function from 2000 to 2018. The study also aimed to determine publication patterns and authorship and to identify recent trends for research in this field. MATERIAL AND METHODS Publications on the association between cognitive function and pain between 2000 and 2018 were identified from the Web of Science database. Bibliographic information, including authorship, country, citation frequency, changes in citation, and interactive visualization were generated using CiteSpace software. Co-citation, or frequency of two publications cited together by another publication, was also studied. RESULTS On 8th January 2019, 4,889 publications were identified. The United States (1132 publications) and the University of Washington (87 publications) were the most productive country and institution, respectively. The journal, Pain (182 publications) had the largest number of publications and was the most frequently cited journal (citation counts, 1569) with the highest centrality (0.62). Author A had the largest number of publications (21). Author B had the greatest co-citation count (223). Author C tied with Author D as the first co-cited author in terms of centrality (0.18). Author E in 2011 (co-citation count, 96) and Author F in 2008 (centrality: 0.11) had the highest co-citation counts and centrality, respectively. The keyword 'empathy' ranked first for research developments with the highest citation burst (10.045). CONCLUSIONS Bibliometric analysis of the association between pain and cognitive function might identify new directions for future research.
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Affiliation(s)
- Kangyong Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,The Fifth Clinical College, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China (mainland)
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Haugmark T, Hagen KB, Smedslund G, Zangi HA. Mindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses. PLoS One 2019; 14:e0221897. [PMID: 31479478 PMCID: PMC6719827 DOI: 10.1371/journal.pone.0221897] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/17/2019] [Indexed: 12/26/2022] Open
Abstract
Objectives To analyze health effects of mindfulness- and acceptance-based interventions, including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT). Additionally, we aimed to explore content and delivery components in terms of procedure, instructors, mode, length, fidelity and adherence in the included interventions. Methods We performed a systematic literature search in the databases MEDLINE, PsychINFO, CINAHL, EMBASE, Cochrane Central and AMED from 1990 to January 2019. We included randomized and quasi-randomized controlled trials analyzing health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia compared to no intervention, wait-list control, treatment as usual, or active interventions. MBSR combined with other treatments were included. Predefined outcomes were pain, fatigue, sleep quality, psychological distress, depression, anxiety, mindfulness, health-related quality of life and work ability. The Template for Intervention Description and Replication (TIDieR) checklist and guide was used to explore content and delivery components in the interventions. Meta-analyses were performed, and GRADE was used to assess the certainty in the evidence. Results The search identified 4430 records, of which nine original trials were included. The vast majority of the participants were women. The analyses showed small to moderate effects in favor of mindfulness- and acceptance-based interventions compared to controls in pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), mindfulness (SMD -0.40 [-0.69, -0.11]), sleep quality (SMD -0.33 [-0.70, 0.04]) and health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]) at end of treatment. The effects are uncertain due to individual study limitations, inconsistent results and imprecision. Conclusion Health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia are promising but uncertain. Future trials should consider investigating whether strategies to improve adherence and fidelity of mindfulness- and acceptance-based interventions can improve health outcomes.
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Affiliation(s)
- Trond Haugmark
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Kåre Birger Hagen
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Division of Health Service, Norwegian Institute of Public health, Oslo, Norway
| | - Geir Smedslund
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Division of Health Service, Norwegian Institute of Public health, Oslo, Norway
| | - Heidi A. Zangi
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Health, VID Specialized University, Oslo, Norway
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Janevic MR, Shute V, Connell CM, Piette JD, Goesling J, Fynke J. The Role of Pets in Supporting Cognitive-Behavioral Chronic Pain Self-Management: Perspectives of Older Adults. J Appl Gerontol 2019; 39:1088-1096. [PMID: 31215816 PMCID: PMC6920602 DOI: 10.1177/0733464819856270] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Cognitive-behavioral self-management strategies are recommended for older adults with chronic pain. The goal of this study was to explore how pet ownership promotes use of these strategies in everyday life. We conducted four focus groups (N = 25) with dog and cat owners aged ≥70 years with persistent pain. Participants described how their pets affect their daily routines and health, including pain and its management. We analyzed transcripts for salient themes, categorizing them according to their alignment with recommended pain self-management strategies: Mood Management (e.g., increases positive affect), Relaxation/Distraction (e.g., soothing presence), Physical Activity (e.g., dog-walking), Behavioral Activation (e.g., motivates activity even when pain present), Social Activation (e.g., facilitates socializing), and Sleep (e.g., encourages routine). Some participants described negative impacts of pet ownership. Having pets can facilitate behaviors and thoughts that may enhance coping with pain. Testing formal ways of leveraging pets' role may expand nonpharmacological options for chronic pain management.
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Differential Predictors of Pain Severity Over 12 Months Following Noncatastrophic Injury Sustained in a Road Traffic Crash. THE JOURNAL OF PAIN 2019; 20:676-684. [DOI: 10.1016/j.jpain.2018.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 11/27/2018] [Indexed: 11/18/2022]
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47
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CORR Insights®: What Factors Are Associated With Outcomes Scores After Surgical Treatment of Ankle Fractures With a Posterior Malleolar Fragment. Clin Orthop Relat Res 2019; 477:870-871. [PMID: 30844825 PMCID: PMC6437380 DOI: 10.1097/corr.0000000000000671] [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: 01/31/2023]
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Thies KM, Anderson D, Beals-Reid C. Project ECHO Chronic Pain: A Qualitative Analysis of Recommendations by Expert Faculty and the Process of Knowledge Translation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:194-200. [PMID: 31385920 PMCID: PMC6727959 DOI: 10.1097/ceh.0000000000000264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Previous studies of the same Project ECHO Chronic Pain cohort demonstrated that recommendations to primary care providers (PCPs) by expert faculty follow CDC Guidelines for Prescribing Opioids and that participating PCPs change their practice accordingly. The purpose of this study was to identify how expert faculty translates knowledge, so that PCPs can act on it. METHODS One hundred ninety-seven PCPs from 82 practices in 14 states attended at least one Project ECHO Chronic Pain session over 10 months, hosted by a large federally qualified health center. Expert faculty was a multidisciplinary panel of six clinicians. Recommendations for 25 randomly selected case presentations were transcribed, yielding 406 discrete units of data. A thematic analysis contributed to a concept map for knowledge translation. RESULTS Expert faculty addressed psychosocial issues in 40% of recommendations. Three themes represented a familiar clinical decision-making process: recommendations for treatment accounted for risk factors and patient engagement and behavior. A concept map placed the recommendations for selected cases in the first phase of the action cycle in the Knowledge-to-Action framework, where knowledge is shared but not yet acted on. DISCUSSION Project ECHO Chronic Pain is an example of iterative guided practice, wherein expert faculty use published guidelines and professional experience to make recommendations for patient care to PCPs. This occurs using shared social-cultural-historical language and context consistent with social constructivist theories of learning.
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Affiliation(s)
- Kathleen M Thies
- Dr. Thies: PhD, Researcher, Weitzman Institute, Community Health Center, Inc., Middletown, CT. Dr. Anderson: MD, VP/Chief Quality Officer, Weitzman Institute, Community Health Center, Inc., Middletown, CT. Dr. Beals-Reid: MD, Resident, Yale New Haven Hospital, New Haven, CT
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Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:168-182. [PMID: 29408484 PMCID: PMC6067990 DOI: 10.1016/j.pnpbp.2018.01.017] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.
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Affiliation(s)
- S M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA.
| | - R R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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50
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Gatzounis R, Crombez G, S Schrooten MG, S Vlaeyen JW. A break from pain! Interruption management in the context of pain. Pain Manag 2018; 9:81-91. [PMID: 30516435 DOI: 10.2217/pmt-2018-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Activity interruptions, namely temporary suspensions of an ongoing task with the intention to resume it later, are common in pain. First, pain is a threat signal that urges us to interrupt ongoing activities in order to manage the pain and its cause. Second, activity interruptions are used in chronic pain management. However, activity interruptions by pain may carry costs for activity performance. These costs have recently started to be systematically investigated. We review the evidence on the consequences of activity interruptions by pain for the performance of the interrupted activity. Further, inspired by literature on interruptions from other research fields, we suggest ways to improve interruption management in the field of pain, and provide a future research agenda.
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Affiliation(s)
- Rena Gatzounis
- Research Group Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, The Netherlands.,Research Group Health Psychology, Faculty of Psychology & Educational Sciences, University of Leuven, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical & Health Psychology, Faculty of Psychology & Educational Sciences, Ghent University, Belgium
| | - Martien G S Schrooten
- Research Group Health Psychology, Faculty of Psychology & Educational Sciences, University of Leuven, Belgium.,Centre for Health & Medical Psychology, School of Law, Psychology & Social Work, Örebro University, Sweden
| | - Johan W S Vlaeyen
- Research Group Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, The Netherlands.,Research Group Health Psychology, Faculty of Psychology & Educational Sciences, University of Leuven, Belgium
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