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Kumar S, Koschmeder KT, Coffman AR, Glass NA, Keffala VJ, Igram CM, Pugely AJ, Olinger CR. Evaluation of Pain Catastrophizing Scale for surgical referral to pain psychology in patients undergoing spinal surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100330. [PMID: 39021894 PMCID: PMC11254176 DOI: 10.1016/j.xnsj.2024.100330] [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: 04/11/2024] [Accepted: 05/16/2024] [Indexed: 07/20/2024]
Abstract
Background Chronic pain is an issue that affects over 100 million Americans daily. Acceptance and Commitment Therapy (ACT) has been found to be beneficial for patients with chronic pain by focusing provider efforts on teaching coping mechanisms for pain instead of eliminating the pain entirely. Current studies demonstrate that ACT significantly improves post-operative chronic pain scores and outcomes. Methods The 200 patients chosen via random generator were collected and presented to (institution) orthopedic spine surgeons along with additional information such as the patients' history of present illness, Visual Analog Scale (VAS) scores, PROMIS-CAT Pain Interference scores, and status of opiate usage. Surgeons were blinded to the PCS cutoff scores. The (institution) orthopedic spine surgeons then identified which patients they would indicate for ACT and their reasoning. Pre-determined PCS score cut-offs were separately used to determine if a patient was indicated for ACT. Results The effectiveness of this screening tool was based on the frequency at which the surgeons and PCS scores were complimentary. A department epidemiologist assisted in the analysis of the data with the use of a ROC curve. ROC Curve demonstrated an area under the curve of 0.7784 with a Sensitivity of 0.68 and a Specificity of 0.79. The cut point according to Youden's index is 35. The data showed that the PCS is moderately accurate in its ability to distinguish coinciding patients that the [institution] orthopedic spine surgeons referred for ACT. The adjusted cut-point indicates that patients above a PCS of 35 would be referred to ACT by the orthopedic spine surgeons while those below a PCS score of 35 would not be referred. Conclusions Using the PCS, a referral with the department pain psychologist would occur by [institution] orthopedic spinal surgeons for patients that are deemed at-risk with a score of at least 35. The goal following this study is to perform future investigations regarding PCS and ACT with patients regarding chronic opioid use and postoperative outcomes. Patients who would be referred for help with chronic pain would be compared to PCS-referred patients and non-referred patients. Pre-operative ACT would be compared to patient outcomes post-operatively. The future aim is to use the cut-offs established in this study for experimental design to evaluate if PCS-referred patients have better pain management post-operatively as compared to the control and previously referred patients. Level of Evidence Level III diagnostic study.
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Affiliation(s)
- Shray Kumar
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
| | - Katelyn T. Koschmeder
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
| | - Alex R. Coffman
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
| | - Natalie A. Glass
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
| | - Valerie J. Keffala
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
| | - Cassim M. Igram
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
| | - Andrew J. Pugely
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
| | - Catherine R. Olinger
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States
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Gwak J, Park J. Effect of acceptance and commitment therapy on fear of falling and physical activity in Parkinson's disease: a randomised controlled trial. BMJ Neurol Open 2024; 6:e000796. [PMID: 39224581 PMCID: PMC11367376 DOI: 10.1136/bmjno-2024-000796] [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: 06/09/2024] [Accepted: 07/28/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction This study aimed to evaluate the efficacy of acceptance and commitment therapy (ACT) in reducing the fear of falling (FOF) and promoting physical activity in individuals diagnosed with Parkinson's disease (PD). Methods and analysis This is a prospective, multicentre, rater-blinded and randomised controlled trial. Patients with PD and a history of falls will be randomly assigned to either an 8-week ACT intervention group or a control group receiving standard care. The primary outcomes measured will include FOF assessment using the Falls Efficacy Scale-International and physical activity levels measured via wearable sensor devices. Secondary outcomes will encompass the assessment of motor function, balance and fall frequency using the Movement Disorder Society Unified Parkinson's Disease Rating Scale, Berg Balance Scale and Timed Up and Go test. Objective measures of balance and physical activity will be obtained through static posturography and wearable sensors over a 3-day period, both before and after the intervention. Data will be analysed using mixed-effects models to evaluate the impact of ACT on FOF and physical activity. Ethics and dissemination We hypothesised that ACT would lead to a significant reduction in FOF and an increase in physical activity levels compared with standard care. Additionally, this study will also examine the relationship between reduced FOF and improvements in balance and motor function. Our results will provide valuable evidence to support the effectiveness of ACT in reducing FOF and promoting physical activity among patients with PD, and if validated, ACT could be recommended as a beneficial intervention to enhance the quality of life and reduce fall-related morbidity in patients with PD.
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Affiliation(s)
- Jiyoung Gwak
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Korea (the Republic of)
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Korea (the Republic of)
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Stein MD, Bendiks S, Karzhevsky S, Pierce C, Dunn A, Majeski A, Herman DS, Weisberg RB. Study protocol for the Treating Opioid Patients' Pain and Sadness (TOPPS) study - A randomized control trial to lower depression and chronic pain interference, and increase care retention among persons receiving buprenorphine. Contemp Clin Trials 2024; 143:107608. [PMID: 38878997 DOI: 10.1016/j.cct.2024.107608] [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: 02/06/2024] [Revised: 05/31/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Persons receiving prescription buprenorphine for opioid use disorder experience high rates of comorbid conditions such as chronic pain and depression, which present barriers to buprenorphine care retention. This paper describes the protocol of the TOPPS (Treating Opioid Patients' Pain and Sadness) study, which compares a values-based, behavioral activation intervention with a health education contact-control condition, with the aim of decreasing chronic pain and depression, and increasing buprenorphine care retention for persons with opioid use disorder. METHODS This randomized controlled trial (RCT) enrolls and randomizes up to 250 participants currently being treated with buprenorphine to receive three months of either TOPPS, a six-session phone-based behavioral intervention, or a health education (HE) control condition. We compare the TOPPS intervention to HE on the following outcomes: 1) pain interference and pain severity over the 3-month treatment phrase; 2) depressive symptoms over the 3-month treatment phase; and 3) sustained improvements in pain interference, depressive symptoms, and buprenorphine treatment retention over the 12-month study period. We also examine mechanisms by which the intervention may reduce pain interference. DISCUSSION This RCT explores a novel intervention to address chronic pain and depression for individuals receiving buprenorphine in office-based settings. TOPPS may lead to improved pain, depression, and substance use outcomes, and can utilize providers available within buprenorphine programs, broadening the disseminability of this intervention and heightening its public health impact. CLINICAL TRIAL #NCT03698669.
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Affiliation(s)
- Michael D Stein
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
| | - Skylar Karzhevsky
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Claire Pierce
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Ana Dunn
- Department of Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA
| | - Adam Majeski
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA; Department of Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA.
| | - Risa B Weisberg
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 720 Harrison Avenue, 9(th) Floor, Boston, MA 02118, USA; Department of Family Medicine, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA; RealizedCare, 1690 Ring Road #110, Elizabethtown, KY 42701, USA.
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Wirtz MR, Revenson TA, Ford JS, Karas AN. Effective Interventions for Idiopathic Chronic Pelvic Pain: A Systematic Review. Int J Behav Med 2024:10.1007/s12529-024-10309-y. [PMID: 39048889 DOI: 10.1007/s12529-024-10309-y] [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: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Chronic pelvic pain (CPP) in women is a debilitating condition with symptoms that affect both medical and psychological systems, yet for those with idiopathic CPP (i.e., those without a known physiologic cause), no consensus for intervention exists. AIM A systematic review was conducted to identify the effectiveness of current biomedical, psychosocial, and integrative interventions for idiopathic CPP (ICPP). METHOD Five databases (PubMed, CINAHL, Cochrane, PsycInfo, Web of Science) were systematically searched with multiple keywords for publications from 2008-2022. Articles were coded for sample characteristics, research design, type of intervention, and intervention outcomes. RESULTS Nineteen studies met criteria. The majority of the interventions (14 studies) were biomedical, either invasive (e.g., injections), or non-invasive (e.g., medications). Five studies evaluated integrative interventions that combined biomedical and psychosocial components (e.g., a multimodal pain treatment center). Invasive biomedical interventions were better at relieving short-term pain and non-invasive biomedical interventions were superior for long-term pain; integrated interventions reduced both short-term and long-term pain. Integrative interventions also improved mental health, sexual health, and QOL. CONCLUSION Although most interventions for ICPP have been biomedical, integrative interventions showed greater outcome effectiveness, suggesting a focus on integrative interventions in the future.
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Affiliation(s)
- Megan R Wirtz
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US.
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY10065, US.
| | - Tracey A Revenson
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY10065, US
| | - Jennifer S Ford
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY10065, US
| | - Alexandra N Karas
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, US
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Paschali M, Thompson GS, Mehta S, Howard PM, Yamin JB, Edwards RR, Donnino MW. Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale. FRONTIERS IN PAIN RESEARCH 2024; 5:1328495. [PMID: 39091382 PMCID: PMC11291320 DOI: 10.3389/fpain.2024.1328495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/24/2024] [Indexed: 08/04/2024] Open
Abstract
Chronic pain syndromes affect over one-third of the US adult population and often lead to significant disability and a reduced quality of life. Despite their high prevalence, causal links between chronic pain syndromes and anatomic abnormalities are often not apparent. Most current chronic pain treatments provide modest, if any, relief. Thus, there is a pressing need to understand the causal mechanisms implicated in chronic pain as a means to develop more targeted interventions for improvement in clinical outcomes and reduction in morbidity and financial burden. In the present manuscript, we summarize the current literature on treatment for chronic pain, and hypothesize that non-specific chronic back pain (without a clear organic etiology, such as tumors, infections or fractures) is of psychophysiologic origin. Based on this hypothesis, we developed Psychophysiologic Symptom Relief Therapy (PSRT), a novel pain reduction intervention for understanding and treating chronic pain. In this manuscript, we provide the rationale for PSRT, which we have tested in a pilot trial with a subsequent larger randomized trial underway. In the proposed trial, we will evaluate whether non-specific chronic back pain can be treated by addressing the underlying stressors and psychological underpinnings without specific physical interventions.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Garrett S. Thompson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shivani Mehta
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Patricia M. Howard
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jolin B. Yamin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Casey MB, Takemasa S, O'Reilly T, Leamy M, Mc Kearney E, Buckley M, Smart KM, Segurado R, Lowry D, Flanagan D, Gopal H, Hearty C, Doody C. Exercise combined with Acceptance and Commitment Therapy for chronic pain: One-year follow-up from a randomized controlled trial. Eur J Pain 2024; 28:913-928. [PMID: 38348557 DOI: 10.1002/ejp.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) is a type of Cognitive Behavioural Therapy, which has demonstrated positive outcomes in individuals with chronic pain. The purpose of this study was to compare the effect of an 8-week programme combining Exercise with Acceptance and Commitment Therapy (ExACT) with a standalone supervised exercise programme at 1-year follow-up. METHODS One hundred and seventy-five people with chronic pain were randomly assigned to ExACT or supervised exercise only. The primary outcome was pain interference measured with the Brief Pain Inventory-Interference Scale. Secondary and treatment process outcomes included pain severity, depression, anxiety, pain catastrophizing, pain self-efficacy, fear avoidance, pain acceptance, committed action, healthcare utilization, patient satisfaction, and global impression of change. Estimates of treatment effects at 1-year follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. RESULTS Eighty-three participants (47.4%) returned the outcome measures at 1-year follow-up. No significant difference was observed between the groups for the primary outcome, pain interference. There was a statistically significant difference between the groups, in favour of ExACT for pain catastrophizing. Within group improvements that were observed within both groups at earlier timepoints were maintained at 1-year follow-up for many of the secondary and treatment process outcomes. ExACT group participants reported higher levels of satisfaction with treatment and global perceived change. CONCLUSIONS The study results showed no significant difference between the two groups for the primary outcome pain interference at 1-year follow-up. Future research could investigate factors that may predict and optimize outcomes from these types of intervention for people living with chronic pain. SIGNIFICANCE Few previous randomized controlled trials investigating ACT for chronic pain have included long-term follow-up. This study found that Exercise combined with ACT was not superior to supervised exercise alone for reducing pain interference at 1-year follow-up. Further research is necessary to identify key processes of therapeutic change and to explore how interventions may be modified to enhance clinical outcomes for people with chronic pain.
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Affiliation(s)
- M B Casey
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - S Takemasa
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Clinical Development, Clinical Development Centre, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - T O'Reilly
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Leamy
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - E Mc Kearney
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Buckley
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - K M Smart
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - R Segurado
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - D Lowry
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D Flanagan
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Doody
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
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Klein MR, Darnall BD, You DS. Feasibility of Web-Based Single-Session Empowered Relief in Patients With Chronic Pain Taking Methadone or Buprenorphine: Protocol for a Single-Arm Trial. JMIR Res Protoc 2024; 13:e53784. [PMID: 38843513 PMCID: PMC11190622 DOI: 10.2196/53784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Chronic pain affects tens of millions of US adults and continues to rise in prevalence. Nonpharmacologic behavioral pain treatments are greatly needed and yet are often inaccessible, particularly in settings where medication prescribing is prioritized. OBJECTIVE This study aims to test the feasibility of a live-instructor, web-based 1-session pain relief skills class in an underserved and potentially at-risk population: people with chronic pain prescribed methadone or buprenorphine either solely for pain or for comorbid opioid use disorder (OUD). METHODS This is a national, prospective, single-arm, uncontrolled feasibility trial. The trial is untethered from medical care; to enhance participants' willingness to join the study, no medical records or drug-monitoring records are accessed. At least 45 participants will be recruited from outpatient pain clinics and from an existing research database of individuals who have chronic pain and are taking methadone or buprenorphine. Patient-reported measures will be collected at 6 time points (baseline, immediately post treatment, 2 weeks, and months 1-3) via a web-based platform, paper, or phone formats to include individuals with limited internet or computer access and low literacy skills. At baseline, participants complete demographic questions and 13 study measures (Treatment Expectations, Body Pain Map, Medication Use, Pain Catastrophizing Scale [PCS], Patient-Reported Outcomes Measurement Information System [PROMIS] Measures, and Opioid Craving Scale). Immediately post treatment, a treatment satisfaction and acceptability measure is administered on a 0 (very dissatisfied) to 10 (completely satisfied) scale, with 3 of these items being the primary outcome (perceived usefulness, participant satisfaction, and likelihood of using the skills). At each remaining time point, the participants complete all study measures minus treatment expectations and satisfaction. Participants who do not have current OUD will be assessed for historical OUD, with presence of OUD (yes or no), and history of OUD (yes or no) reported separately. Feasibility threshold is set as an overall group treatment satisfaction rating of 8 of 10. In-depth qualitative interviews will be conducted with about 10 participants to obtain additional data on patient perceptions, satisfactions, needs, and wants. To assess preliminary efficacy, we will examine changes in pain catastrophizing, pain intensity, pain bothersomeness, sleep disturbance, pain interference, depression, anxiety, physical function, global impression of change, and opioid craving at 1 month post treatment. RESULTS This project opened to enrollment in September 2021 and completed the recruitment in October 2023. The data collection was completed in February 2024. Results are expected to be published in late 2024. CONCLUSIONS Results from this trial will inform the feasibility and preliminary efficacy of Empowered Relief in this population and will inform the design of a future randomized controlled trial testing web-based Empowered Relief in chronic pain and comorbid OUD. TRIAL REGISTRATION ClinicalTrials.gov NCT05057988; https://clinicaltrials.gov/study/NCT05057988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53784.
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Affiliation(s)
- Morgan R Klein
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Eastwood F, Godfrey E. The efficacy, acceptability and safety of acceptance and commitment therapy for fibromyalgia - a systematic review and meta-analysis. Br J Pain 2024; 18:243-256. [PMID: 38751564 PMCID: PMC11092929 DOI: 10.1177/20494637231221451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility and has been found to be beneficial in treating chronic pain; however, there are few studies evaluating its efficacy in treating FM. Aim This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia. Methods PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. Results Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD -1.05, 95% CI -2.02, -0.09) and follow-up (SMD -1.43, 95% CI -2.17, -0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain and disability. Fatigue also improved, with a large negative effect. Conclusions The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies.
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Affiliation(s)
- Florence Eastwood
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | - Emma Godfrey
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Cojocaru CM, Popa CO, Schenk A, Jakab Z, Suciu BA, Olah P, Popoviciu H, Szasz S. A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders. Behav Sci (Basel) 2024; 14:327. [PMID: 38667123 PMCID: PMC11047417 DOI: 10.3390/bs14040327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting. MATERIALS AND METHODS A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month. RESULTS Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72). CONCLUSIONS The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.
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Affiliation(s)
- Cristiana-Manuela Cojocaru
- The Doctoral School of George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.)
| | - Cosmin Octavian Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Alina Schenk
- The Doctoral School of George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.)
| | - Zsolt Jakab
- Department of Counseling, Career Guidance and Informing Students, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania;
| | - Bogdan Andrei Suciu
- Department of Anatomy and Morphological Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu-Mures, Romania;
| | - Peter Olah
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania;
| | - Horațiu Popoviciu
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (H.P.); (S.S.)
| | - Simona Szasz
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (H.P.); (S.S.)
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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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11
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Polhill SE, Lape EC, Deyo AG, Smit T, Zvolensky MJ, Zale EL, Ditre JW. Pain Intensity, Pain-Related Anxiety, and Hazardous Drinking Among Individuals With PTSD. J Dual Diagn 2024; 20:122-131. [PMID: 38408374 DOI: 10.1080/15504263.2024.2319034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Evidence suggests that pain intensity may be indirectly linked to hazardous drinking and PTSD symptom severity via pain-related anxiety. The goal of this analysis was to test the hypotheses in a population with PTSD symptoms that pain intensity would be positively and indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via pain-related anxiety. METHODS Heavy drinkers with probable PTSD were recruited via Qualtrics panels (N = 371, 53% Female, Mage = 39.68, SD = 10.86). Linear regression and conditional process models were conducted to examine indirect associations between pain intensity and primary outcomes via pain-related anxiety. RESULTS Pain intensity was found to be indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via greater pain-related anxiety. CONCLUSION These initial findings suggest that pain-related anxiety may play an important role in relations between the experience of pain and hazardous patterns of alcohol consumption among individuals with probable PTSD. Future research is needed to determine the temporal nature of these associations and to examine the potential utility of treatments that address pain-related anxiety in the context of comorbid pain, PTSD, and hazardous drinking.
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Affiliation(s)
- Sarah E Polhill
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Emma C Lape
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - T Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - M J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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12
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Choukas NR, Mace RA, Rochon EA, Brewer JR, Vranceanu AM. Exploring mechanisms of improvement in the Active Brains intervention for older adults with chronic pain and early cognitive decline. Arch Gerontol Geriatr 2024; 118:105290. [PMID: 38056101 PMCID: PMC11056800 DOI: 10.1016/j.archger.2023.105290] [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: 09/26/2023] [Revised: 11/11/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES We iteratively developed, optimized, and established the feasibility of a virtual, group-based, mind-body activity program (Active Brains, AB), supported by Fitbit for older adults with chronic pain (CP) and early cognitive decline (ECD). Guided by the principles of the NIH stage model we 1) explore signals of improvement in AB outcomes and hypothesized mechanisms of action and 2) explore relationships between changes in outcomes with changes in mechanisms. METHODS Participants were N = 15 older adults (age ≥ 60) with CP-ECD from two NIH stage 1 pilot studies of AB. We conducted paired t-tests to explore pre-post improvements, and correlations to investigate associations between changes in outcomes and mechanisms. RESULTS We observed small to large improvements across co-primary and secondary outcomes (d = 0.24-1.09). We observed small to medium improvements in 4 out of 5 hypothesized mechanisms (d = 0.23-0.47). Overall, improvements in outcomes had moderate to large associations with improvements in hypothesized mechanisms. CONCLUSION AB was associated with improvements across several co-primary and secondary outcomes, and hypothesized mechanisms. Pain-specific coping and general coping skills are promising treatment targets to address the CP-ECD comorbidity among older adults.
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Affiliation(s)
- Nathaniel R Choukas
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Rochon
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Julie R Brewer
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Martinez-Calderon J, García-Muñoz C, Rufo-Barbero C, Matias-Soto J, Cano-García FJ. Acceptance and Commitment Therapy for Chronic Pain: An Overview of Systematic Reviews with Meta-Analysis of Randomized Clinical Trials. THE JOURNAL OF PAIN 2024; 25:595-617. [PMID: 37748597 DOI: 10.1016/j.jpain.2023.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
This overview of reviews aimed to summarize the evidence from systematic reviews and meta-analyses of randomized clinical trials of the efficacy of acceptance and commitment therapy (ACT) for adults with chronic pain in relation to pain intensity, pain-related functioning, quality of life, and psychological factors. The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, and the Cochrane Library databases were searched from inception to July 2, 2023. AMSTAR 2 was used to assess the methodological quality of systematic reviews. The overlap among reviews was calculated. Nine reviews comprising 84 meta-analyses of interest were included. At post-treatment, some meta-analyses mainly showed that ACT can reduce depression symptoms, anxiety symptoms, psychological inflexibility, and pain catastrophizing; and can improve mindfulness, pain acceptance, and psychological flexibility. At three-month follow-up, ACT can reduce depression symptoms and psychological inflexibility, as well as improve pain-related functioning and psychological flexibility. At six-month follow-up, ACT can improve mindfulness, pain-related functioning, pain acceptance, psychological flexibility, and quality of life. At six-twelve-month follow-up, ACT can reduce pain catastrophizing and can improve pain-related functioning. Some methodological and clinical issues are identified in the reviews, such as a very high overlap between systematic reviews, the fact that the certainty of the evidence is often not rated and specific details needed to replicate the interventions reviewed are often not reported. Overall, however, randomized clinical trials and systematic reviews show that ACT can improve outcomes related to chronic pain (eg, pain-related functioning). Future systematic reviews should address the methodological and clinical concerns identified here to produce higher-quality findings. PERSPECTIVE: Despite certain methodological and clinical issues, randomized clinical trials and systematic reviews of ACT appear to show that it can improve outcomes related to chronic pain (eg, psychological factors).
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Affiliation(s)
- Javier Martinez-Calderon
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain; CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain
| | - Cristina García-Muñoz
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain; Universidad Loyola de Andalucía, Sevilla, Spain
| | - Carmen Rufo-Barbero
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, Sevilla, Spain
| | - Javier Matias-Soto
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain; Universidad de Malaga, Faculty of Health Sciences, Department of Physical Therapy, Malaga, Spain
| | - Francisco J Cano-García
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, Sevilla, Spain
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Blake J, Beazley P, Steverson T. An evaluation of an open group for depressed mood on a stroke rehabilitation ward: three years of clinical data. Disabil Rehabil 2024; 46:939-946. [PMID: 36916395 DOI: 10.1080/09638288.2023.2186498] [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: 07/29/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE An open group intervention for stroke inpatients, based on Acceptance and Commitment Therapy, is evaluated using retrospective clinical service data. MATERIALS AND METHODS Participants were included unless severely unwell or unable to provide informed consent. 117 participants attended at least two sessions in a non-controlled, repeated measures design. Two session protocols were delivered on alternating weeks by an Assistant Psychologist and Trainee Psychologist, covering values, committed action, and acceptance. Participants rated their mood each session using the Depression Intensity Scale Circles (DISCs). RESULTS Attended sessions ranged from 1 to 11 (Md: 2). Significant reductions in DISCs scores with medium effect sizes were found among those scoring above the cut-off for depression at baseline, Χ2(3) = 20.87, p < .001. The likelihood of scoring below the cut-off for depression did not change between participants' first and last sessions, X2(1, N = 117) = 1.36, p = .24. The number of sessions attended did not predict outcome, rs(117) = .09, p = .33. CONCLUSIONS Design limitations prevented inferences of clinical effectiveness, but the group met several clinical utility criteria by providing a flexible intervention on a rehabilitation ward with competing demands. We highlight the importance of contrasting findings of clinical trials with data from clinical services.
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Affiliation(s)
- Joshua Blake
- Clinical Psychology, University of East Anglia, Norwich, UK
| | - Peter Beazley
- Deputy Course Director, Doctorate in Clinical Psychology, University of East Anglia, Norwich, UK
| | - Tom Steverson
- Clinical Psychologist, Norfolk Community Health and Care NHS Trust and University of East Anglia, Norwich, UK
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15
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Mauck MC, Aylward AF, Barton CE, Birckhead B, Carey T, Dalton DM, Fields AJ, Fritz J, Hassett AL, Hoffmeyer A, Jones SB, McLean SA, Mehling WE, O'Neill CW, Schneider MJ, Williams DA, Zheng P, Wasan AD. [Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach : German version]. Schmerz 2024:10.1007/s00482-024-00798-x. [PMID: 38381187 DOI: 10.1007/s00482-024-00798-x] [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: 01/29/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. OBJECTIVE The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. METHODS A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. CONCLUSION The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.
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Affiliation(s)
- Matthew C Mauck
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA.
| | - Aileen F Aylward
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chloe E Barton
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Brandon Birckhead
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Carey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane M Dalton
- Department of Physical Therapy, Boston University, College of Health and Rehabilitation Sciences, Sargent, Boston, MA, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Hoffmeyer
- University of North Carolina at Chapel Hill, Collaborative Studies Coordinating Center, Chapel Hill, NC, USA
| | - Sara B Jones
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Conor W O'Neill
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Michael J Schneider
- Department of Physical Therapy and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Patricia Zheng
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Ajay D Wasan
- Departments of Anesthesiology and Perioperative Medicine and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Paschali M, Lazaridou A, Sadora J, Papianou L, Garland EL, Zgierska AE, Edwards RR. Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis. Clin J Pain 2024; 40:105-113. [PMID: 37942696 DOI: 10.1097/ajp.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the United States each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized. DESIGN Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs), pilot RCTs, and single-arm studies that explored the effectiveness of MBIs in CLBP. METHODS Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7. RESULTS Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included mindfulness meditation, mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-oriented recovery enhancement, acceptance and commitment therapy, dialectical behavioral therapy, meditation-cognitive behavioral therapy, mindfulness-based care for chronic pain, self-compassion course, and loving-kindness course. Pain intensity scores were reported using a numerical rating scale (0 to 10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP. CONCLUSIONS MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data the high variability in study methodologies, small sample sizes, inclusion of studies with high risk of bias, and reliance on pre-post treatment differences with no attention to maintenance of effects. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
- Fielding Graduate University, Santa Barbara, CA
| | | | - Lauren Papianou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development
- College of Social Work, University of Utah, Salt Lake City, UT
| | - Aleksandra E Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
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Ceulemans D, Moens M, Reneman M, Callens J, De Smedt A, Godderis L, Goudman L, Lavreysen O, Putman K, Van de Velde D. Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis. J Rehabil Med 2024; 56:jrm13454. [PMID: 38226563 PMCID: PMC10802789 DOI: 10.2340/jrm.v56.13454] [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: 06/06/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. DESIGN A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. METHODS Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. RESULTS Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. CONCLUSION This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.
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Affiliation(s)
- Dries Ceulemans
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium; STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium.
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Michiel Reneman
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jonas Callens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Ann De Smedt
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Lode Godderis
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium; IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Olivia Lavreysen
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Dominique Van de Velde
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium
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18
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Bruger J, Semlyen J, Ford CEL. "I will try anything" the experience of working age stroke survivors living with chronic post-stroke pain: an interpretative phenomenological analysis. Disabil Rehabil 2023:1-10. [PMID: 38059370 DOI: 10.1080/09638288.2023.2288688] [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: 12/28/2022] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK). METHODS Semi-structured interviews were conducted with eight working age (46-64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis. RESULTS The analysis led to three Group Experiential Themes: "The Solitude of the Pain Experience," "Unsatisfactory Healthcare and the Need for Self-Care" and "The Development of Pain Acceptance." Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain. CONCLUSIONS The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions.
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Affiliation(s)
- Johanna Bruger
- North East London NHS Foundation Trust, Rainham, UK
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joanna Semlyen
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Catherine Elaine Longworth Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
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19
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Connolly ME, Forman S, Sharkey CM, Merwin S, Darbari DS, Hardy SJ. Feasibility and preliminary efficacy of the Balance Program to reduce pain-related disability in pediatric sickle cell disease. Pediatr Blood Cancer 2023; 70:e30667. [PMID: 37726889 DOI: 10.1002/pbc.30667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) pain is associated with functional impairment, and treatment is often limited to pharmacological approaches with unwanted side effects. Although behavioral interventions exist for non-SCD pain populations, interventions designed to address pain-related impairment in SCD are lacking. METHODS Twenty youth (9-17 years) with SCD completed a four-week telemedicine pain intervention (NCT04388241). Participants and caregivers completed baseline and post-intervention PROMIS pain measures and the Treatment Evaluation Inventory-Short Form (TEI-SF). Descriptive analyses assessed feasibility and acceptability. Reliable Change Index analyses assessed for significant post-intervention changes in pain functioning. Paired t test analyses compared baseline and post-intervention opioid prescription fills. RESULTS All participants completed at least one treatment session. Eighteen (90%) youth completed all sessions. Youth (100%) and caregivers (94%) rated the intervention as moderately or highly acceptable on the TEI-SF. Forty-seven percent of caregivers and 44% of youth reported reliably significant improvements in pain interference after the intervention (median T-score differences: 24.8 and 23.5, respectively). Sixty-five percent of caregivers (T-score improvement difference: 19.3) and 31% of youth (T-score improvement difference: 32) reported improvements in pain behaviors. There was no significant difference in opioid prescription fills pre- and post-intervention (P > 0.05). CONCLUSIONS The Balance Program is feasible, highly acceptable, and can be delivered remotely to reduce barriers to care. Approximately half of youth and caregivers reported significant declines in pain interference following the intervention, with substantial improvements in functioning for treatment responders. Behavioral pain interventions are important adjunctive treatments to uniquely address functional impairment associated with acute and chronic pain in SCD.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sydney Forman
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Christina M Sharkey
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Stephanie Merwin
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Deepika S Darbari
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
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20
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Adamowicz JL, Sirotiak Z, Thomas EB. Psychological flexibility and global health in young adults with and without a self-reported functional somatic syndrome: a preliminary investigation. PSYCHOL HEALTH MED 2023; 28:3091-3106. [PMID: 37227813 PMCID: PMC11062592 DOI: 10.1080/13548506.2023.2216940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
Functional somatic syndromes (FSS) are associated with functional impairments and distress. FSSs are common among young adults, and psychological flexibility may be a transdiagnostic process appropriate for treatment of FSS in this population. The objective of the current study was to compare physical and mental health in young adults with and without a self-reported FSS and examine which psychological flexibility processes are associated with better physical and mental health in the FSS subset. A total of 447 young adults participated in the current study. Individuals who reported an FSS diagnosis were coded as having a self-reported FSS. Physical and mental health and psychological flexibility were measured via self-report. FSS and non-FSS groups were compared regarding demographic characteristics and on the primary outcomes. Hierarchical regression analyses were conducted to examine the role of the psychological flexibility processes in physical and mental health in the FSS subset. Findings revealed that the FSS group scored significantly lower on measures of physical health and demonstrated less behavioral awareness than the non-FSS group. No differences regarding mental health were found. All three psychological flexibility processes were associated with physical and mental health, accounting for 26-49% of the variance in these outcomes. In conclusion, young adults with FSS experience more physical health difficulties than those without FSS. Psychological flexibility processes were related to better physical and mental health in those with FSS. These findings add to the literature and provide preliminary support for psychological flexibility as a future target for intervention development and implementation aimed at young adults with FSS.
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Affiliation(s)
| | - Zoe Sirotiak
- University of Iowa, Department of Psychological and Brain Sciences
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21
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Forden G, Ronaghan S, Williams P, Fish S, Ford C. Predictors of treatment outcome in cognitive behavioural therapy for chronic pain: a systematic review. Disabil Rehabil 2023:1-12. [PMID: 38018474 DOI: 10.1080/09638288.2023.2283113] [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: 04/10/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The aim of this systematic review was to synthesise the research identifying possible influences on CBT outcomes in chronic pain. Variations in the effectiveness of psychological therapies, such as CBT, in chronic pain have led to research investigating predictors of improved treatment outcomes. MATERIALS AND METHODS We identified randomised controlled and cohort studies of CBT for chronic pain, published between 1974 to 2nd August 2023, which identified predictors of CBT outcomes. RESULTS Nineteen studies were included in the review. Baseline sociodemographic, physical and emotional factors that influence the outcomes of CBT for chronic pain were identified. The most commonly reported predictors of CBT outcome, with medium to large effect sizes, were anxiety, depression and negative cognitions about pain and coping. Sociodemographic predictors of outcomes demonstrated small effects and lacked replicability. CONCLUSIONS There was variability across study designs, CBT delivery and outcomes measures. Further research is needed in chronic pain to identify the predictive factors which influence treatment outcomes, and consistency across study designs and outcome variables is needed to reduce heterogeneity.
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Affiliation(s)
- Georgina Forden
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Ronaghan
- Psychological Medicine, Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarah Fish
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Catherine Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
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22
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Lu C, Moliadze V, Nees F. Dynamic processes of mindfulness-based alterations in pain perception. Front Neurosci 2023; 17:1253559. [PMID: 38027503 PMCID: PMC10665508 DOI: 10.3389/fnins.2023.1253559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Mindfulness-based processes have been shown to enhance attention and related behavioral responses, including analgesia, which is discussed as an effective method in the context of pain interventions. In the present review, we introduce the construct of mindfulness, delineating the concepts, factors, and processes that are summarized under this term and might serve as relevant components of the underlying mechanistic pathways in the field of pain. We also discuss how differences in factors such as definitions of mindfulness, study design, and strategies in mindfulness-based attention direction may need to be considered when putting the findings from previous studies into a whole framework. In doing so, we capitalize on a potential dynamic process model of mindfulness-based analgesia. In this respect, the so-called mindfulness-based analgesia may initially result from improved cognitive regulation strategies, while at later stages of effects may be driven by a reduction of interference between both cognitive and affective factors. With increasing mindfulness practice, pathways and mechanisms of mindfulness analgesia may change dynamically, which could result from adaptive coping. This is underlined by the fact that the neural mechanism of mindfulness analgesia is manifested as increased activation in the ACC and aINS at the beginner level while increased activation in the pINS and reduced activation in the lPFC at the expert level.
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Affiliation(s)
| | | | - Frauke Nees
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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23
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Vandael K, Vervliet B, Peters M, Meulders A. Excessive generalization of pain-related avoidance behavior: mechanisms, targets for intervention, and future directions. Pain 2023; 164:2405-2410. [PMID: 37498749 PMCID: PMC10578424 DOI: 10.1097/j.pain.0000000000002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Kristof Vandael
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
- Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
| | - Bram Vervliet
- Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
| | - Madelon Peters
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
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24
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Jensen MP, Ehde DM, Hakimian S, Pettet MW, Day MA, Ciol MA. Who Benefits the Most From Different Psychological Chronic Pain Treatments? An Exploratory Analysis of Treatment Moderators. THE JOURNAL OF PAIN 2023; 24:2024-2039. [PMID: 37353183 PMCID: PMC10615716 DOI: 10.1016/j.jpain.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
Different psychological chronic pain treatments benefit some individuals more than others. Understanding the factors that are associated with treatment response-especially when those factors differ between treatments-may inform more effective patient-treatment matching. This study aimed to identify variables that moderate treatment response to 4 psychological pain interventions in a sample of adults with low back pain or chronic pain associated with multiple sclerosis, spinal cord injury, acquired amputation, or muscular dystrophy (N = 173). The current study presents the results from secondary exploratory analyses using data from a randomized controlled clinical trial which compared the effects of 4 sessions of cognitive therapy (CT), hypnosis focused on pain reduction (HYP), hypnosis focused on changing pain-related cognitions and beliefs (HYP-CT), and a pain education control condition (ED). The analyses tested the effects of 7 potential treatment moderators. Measures of primary (pain intensity) and secondary (pain interference, depression severity) outcome domains were administered before and after the pain treatments, and potential moderators (catastrophizing, hypnotizability, and electroencephalogram (EEG)-assessed oscillation power across five bandwidths) were assessed at pre-treatment. Moderator effects were tested fitting regression analyses to pre- to post-treatment changes in the three outcome variables. The study findings, while preliminary, support the premise that pre-treatment measures of hypnotizability and EEG brain activity predict who is more (or less) likely to respond to different psychological pain treatments. If additional research replicates the findings, it may be possible to better match patients to their more individually suitable treatment, ultimately improving pain treatment outcomes. PERSPECTIVE: Pre-treatment measures of hypnotizability and EEG-assessed brain activity predicted who was more (or less) likely to respond to different psychological pain treatments. If these findings are replicated in future studies, they could inform the development of patient-treatment matching algorithms.
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Affiliation(s)
- Mark P. Jensen
- 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
| | - Shahin Hakimian
- 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
| | - Melissa A. Day
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Marcia A. Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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25
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Pilevar S, Teymouri S, Bayazi MH, Rajaei AR. The effectiveness of acceptance and commitment therapy (ACT) on illness perception in orthopedic patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:342. [PMID: 38144033 PMCID: PMC10743938 DOI: 10.4103/jehp.jehp_918_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/27/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND Orthopedic pain is diagnosed and treated as a global health problem. Therapeutic interventions can change the behavior of patients and improve their quality of life. This study was aimed to evaluate the effectiveness of acceptance and commitment therapy (ACT) on illness perception among orthopedic patients. MATERIALS AND METHODS This quasi-experimental study was conducted as a two-group design (one experimental group and one control group) with pretest and posttest. Participants were selected from patients referred to the Mooud Physiotherapy Center in Mashhad, Iran. Patients were randomly divided into experimental and control groups (12 in each group). The experimental group received weekly sessions for three months (eight sessions), whereas the control group did not receive any intervention. Data were collected through Weinman's Illness Perception Questionnaire (with Cronbach's alpha coefficient of 0.72). Data were analyzed using multivariate analysis of covariance (MANCOVA). RESULTS The results of the study showed that in terms of time, the outcome, and the meaning of disease, the patients in the ACT group had a lower mean in the posttest. Patients of the ACT group in personal and therapeutic controls showed a higher mean in the posttest than those of the control group. Therefore, ACT had a significant effect on improving the understanding of disease in orthopedic patients (P < 0.05). CONCLUSION Based on the results, ACT has a significant effect on the disease perception of orthopedic patients. Therefore, it is suggested that therapists use this therapy approach to illness perception in orthopedic patients.
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Affiliation(s)
- Sahar Pilevar
- Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran
| | - Saeed Teymouri
- Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran
| | | | - Ali Reza Rajaei
- Department of Psychology, Torbat-e Jam Branch, Islamic Azad University, Torbat-e Jam, Iran
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26
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Polk AN, Smitherman TA. A meta-analytic review of acceptance-based interventions for migraine. Headache 2023; 63:1271-1284. [PMID: 37635382 DOI: 10.1111/head.14614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To determine the efficacy of acceptance and mindfulness-based interventions on migraine disability, medication use, and attack frequency. BACKGROUND Acceptance-based approaches to headache management are those in which individuals learn to mitigate the influence of pain-related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness-based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance-based interventions for headache broadly and migraine specifically, no meta-analytic review of ACT interventions for headache exists, and two meta-analytic reviews of mindfulness-based practices yielded conflicting results. METHODS The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance-based interventions among adults with migraine. A multi-database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness-based interventions to control treatment. Random-effects meta-analyses were performed using RevMan 5.4 meta-analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I2 index and explored via subgroup analyses. RESULTS Acceptance-based interventions yielded significant improvements in disability (SMD = -0.38, 95% CI = -0.56 to -0.20; I2 = 25%, p = 0.20) but not in medication use (SMD = -0.25, 95% CI: -0.57 to 0.06; I2 = 0%, p = 0.82) or headache frequency (SMD = -0.16, 95% CI = -0.37 to 0.05; I2 = 0%, p = 0.73). CONCLUSION Results suggest that acceptance-based interventions are effective in improving disability among adults with migraine and are a viable non-pharmacological treatment option, in addition to well-established behavioral migraine management approaches, for patients seeking functional improvement.
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Affiliation(s)
- Ashley N Polk
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
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27
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Vranceanu AM, Choukas NR, Rochon EA, Duarte B, Pietrzykowski MO, McDermott K, Hooker JE, Kulich R, Quiroz YT, Parker RA, Macklin EA, Ritchie C, Mace RA. Addressing the Chronic Pain-Early Cognitive Decline Comorbidity Among Older Adults: Protocol for the Active Brains Remote Efficacy Trial. JMIR Res Protoc 2023; 12:e47319. [PMID: 37768713 PMCID: PMC10570897 DOI: 10.2196/47319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/01/2023] [Accepted: 05/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chronic pain and early cognitive decline, which are costly to treat and highly prevalent among older adults, commonly co-occur, exacerbate one another over time, and can accelerate the development and progression of Alzheimer disease and related dementias. We developed the first mind-body activity program (Active Brains [AB]) tailored to the needs of older adults with chronic pain and early cognitive decline. Results from our previous study strongly supported the feasibility of conducting AB remotely and provided evidence for improvements in outcomes. OBJECTIVE We are conducting a single-blinded, National Institutes of Health stage-2, randomized clinical trial to establish the efficacy of AB versus a time-matched and dose-matched education control (Health Enhancement Program [HEP]) in improving self-reported and objective outcomes of physical, cognitive, and emotional functions in 260 participants. The methodology described in this paper was informed by the lessons learned from the first year of the trial. METHODS Participants are identified and recruited through multidisciplinary clinician-referred individuals (eg, pain psychologists and geriatricians), the Rally Research platform, social media, and community partnerships. Interested participants complete eligibility screening and electronic informed consent. Baseline assessments include self-report, performance-based measures (eg, 6-min walk test) and objective measures (eg, Repeatable Battery for the Assessment of Neuropsychological Status). Participants are mailed a wrist-worn ActiGraph device (ActiGraph LLC) to passively monitor objective function (eg, steps) during the week between the baseline assessment and the beginning of the programs, which they continue to wear throughout the programs. After baseline assessments, participants are randomized to either AB or HEP and complete 8 weekly, remote, group sessions with a Massachusetts General Hospital psychologist. The AB group receives a Fitbit (Fitbit Inc) to help reinforce increased activity. Assessments are repeated after the intervention and at the 6-month follow-up. Coprimary outcomes include multimodal physical function (self-report, performance based, and objective). Secondary outcomes are cognitive function (self-report and objective), emotional function, and pain. RESULTS We began recruitment in July 2022 and recruited 37 participants across 4 cohorts. Of them, all (n=37, 100%) have completed the baseline assessment, 26 (70%) have completed the posttest assessment, and 9 (24%) are actively enrolled in the intervention (total dropout: n=2, 5%). In the three cohorts (26/37, 70%) that have completed the AB or HEP, 26 (100%) participants completed all 8 group sessions (including minimal makeups), and watch adherence (1937/2072, 93.48%, average across ActiGraph and Fitbit devices) has been excellent. The fourth cohort is ongoing (9/37, 24%), and we plan to complete enrollment by March 2026. CONCLUSIONS We aim to establish the efficacy of the AB program over a time-matched and dose-matched control in a live video-based trial and test the mechanisms through theoretically driven mediators and moderators. Findings will inform the development of a future multisite effectiveness-implementation trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05373745; https://classic.clinicaltrials.gov/ct2/show/NCT05373745. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47319.
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Affiliation(s)
- Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nathaniel R Choukas
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Elizabeth A Rochon
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Brooke Duarte
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Malvina O Pietrzykowski
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Ronald Kulich
- Harvard Medical School, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Yakeel T Quiroz
- Harvard Medical School, Boston, MA, United States
- Multicultural Alzheimer's Prevention Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Robert A Parker
- Harvard Medical School, Boston, MA, United States
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Eric A Macklin
- Harvard Medical School, Boston, MA, United States
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Ritchie
- Harvard Medical School, Boston, MA, United States
- Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Sturgeon JA, Ehde DM, Darnall BD, Barad MJ, Clauw DJ, Jensen MP. Psychological Approaches for Migraine Management. Anesthesiol Clin 2023; 41:341-355. [PMID: 37245946 PMCID: PMC10513739 DOI: 10.1016/j.anclin.2023.02.002] [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] [Indexed: 03/17/2023]
Abstract
Migraine headaches are among the most prevalent and disabling pain conditions worldwide. Best-practice migraine management is multidisciplinary and includes the psychological approaches to address cognitive, behavioral, and affective factors that worsen pain, distress, and disability. The psychological interventions with the strongest research support are relaxation strategies, cognitive-behavioral therapy, and biofeedback, though the quality of clinical trials for all psychological interventions needs continued improvement. The efficacy of psychological interventions may be improved by validating technology-based delivery systems, developing interventions for trauma and life stress, and precision medicine approaches matching treatments to patients based on specific clinical characteristics.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA.
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359612, Seattle, WA 98104, USA
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 430 Broadway Street, Pavilion C, 3rd Floor MC6343, Redwood City, CA 94063, USA
| | - Meredith J Barad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA 94304, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359612, Seattle, WA 98104, USA
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Haun JN, Fowler CA, Venkatachalam HH, Saenger MS, Alman AC, Smith BM, Schneider T, Benzinger R, Stroupe K, French DD. Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans. BMC Health Serv Res 2023; 23:431. [PMID: 37138319 PMCID: PMC10155644 DOI: 10.1186/s12913-023-09327-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA's Stepped Care Model to meet veterans' pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management. OBJECTIVES The Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans' pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation. METHODS A sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO. RESULTS Of 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20-9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p < .003) in the three primary pain outcomes (intensity, interference, catastrophizing), and 12 of 17 secondary outcomes, including physical, psychological, health-related quality of life (HRQoL), acceptance, and mindfulness measures. DISCUSSION Data suggest that EVP has significant positive outcomes in pain, psychological, physical, HRQoL, acceptance, and mindfulness measures for veterans with chronic pain through non-pharmacological means. Future evaluations of intervention dosing effect and long-term effectiveness of the program is needed.
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Grants
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
- OMAT ID# 16403,16404, 16405, 16489, 16490 U.S. Department of Veterans Affairs
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Affiliation(s)
- Jolie N Haun
- Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Christopher A Fowler
- Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA.
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL, 33613, USA.
| | - Hari H Venkatachalam
- Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA
| | - Michael S Saenger
- Anesthesia Service Line, Atlanta Veterans Administration Health Care System, 1670 Clairmont Rd, Decatur, GA, 30033, USA
- Division of Internal Medicine, School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Amy C Alman
- Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Bridget M Smith
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave, Hines, IL, 60141, USA
| | - Tali Schneider
- Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA
| | - Rachel Benzinger
- Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA
| | - Kevin Stroupe
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave, Hines, IL, 60141, USA
| | - Dustin D French
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave, Hines, IL, 60141, USA
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair St. Suite 2000, Chicago, IL, 60611, USA
- Departments of Ophthalmology and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave. Suite 440, Chicago, IL, 60611, USA
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Gentili C, Zetterqvist V, Rickardsson J, Holmström L, Ljótsson B, Wicksell R. Examining predictors of treatment effect in digital Acceptance and Commitment Therapy for chronic pain. Cogn Behav Ther 2023:1-17. [DOI: 10.1080/16506073.2023.2191826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Reilly ED, Kathawalla UK, Robins HE, Heapy AA, Hogan TP, Waring ME, Quigley KS, Drebing CE, Bickmore T, Volonte M, Kelly MM. An Online Acceptance and Mindfulness Intervention for Chronic Pain in Veterans: Development and Protocol for a Pilot Feasibility Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e45887. [PMID: 36881446 PMCID: PMC10031449 DOI: 10.2196/45887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning. OBJECTIVE The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20). METHODS This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system. RESULTS This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023. CONCLUSIONS The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning. TRIAL REGISTRATION ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45887.
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Affiliation(s)
- Erin D Reilly
- Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, Bedford, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ummul-Kiram Kathawalla
- Wheelock College of Education & Human Development, Boston University, Boston, MA, United States
| | | | - Alicia A Heapy
- Pain Research, Informatics, Multi-morbidities, and Education Center, Veterans Affairs Connecticut Healthcare System, Department of Veterans Affairs, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Karen S Quigley
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Charles E Drebing
- Cheyenne Veterans Affairs Medical Center, Department of Veterans Affairs, Cheyenne, WY, United States
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Matias Volonte
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Megan M Kelly
- Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, Bedford, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Liu H, Liu N, Chong ST, Boon Yau EK, Ahmad Badayai AR. Effects of acceptance and commitment therapy on cognitive function: A systematic review. Heliyon 2023; 9:e14057. [PMID: 36938399 PMCID: PMC10015206 DOI: 10.1016/j.heliyon.2023.e14057] [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: 11/15/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
Cognitive function is essential for daily activities. Acceptance and commitment therapy (ACT) may improve cognitive function by enhancing psychological flexibility, but the underlying mechanism is unknown. This systematic review evaluated the effectiveness of ACT on cognitive function. Seven research databases (PubMed, ProQuest Dissertations and Theses, Web of Science, EBSCOhost, CNKI, Scopus, Wanfang) were searched to collect articles with trials published in English and Chinese. After applying inclusion and exclusion criteria, we identified 12 studies published between 1994 and 2022 that included a combined total of 904 participants. Among the included studies were within-group (N = 3) and randomized controlled trial (RCT, N = 9) study designs. Outcome measures included cognitive scales and behavioral measurements. Of the 12 articles, 10 studies showed improvements in certain domains of cognitive function due indirectly to ACT intervention. We found that the ability of ACT intervention to promote psychological flexibility is due to its transdiagnostic nature. Also, the effects of the ACT intervention were observed in multiple cognitive domains: attention, subjective cognitive function, executive function, and memory. In conclusion, cognitive trainers could consider practicing ACT as part of their strategy to enhance an individual's psychological flexibility and cognitive function.
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Affiliation(s)
- Haihong Liu
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia
- Department of Psychology, Chengde Medical University, Chengde, 067000, China
- Hebei International Research Center of Medical Engineering, Chengde Medical University, Chengde, 067000, China
| | - Nan Liu
- Department of Psychology, Chengde Medical University, Chengde, 067000, China
| | - Sheau Tsuey Chong
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia
- Counselling Psychology Programme, Secretariat of Postgraduate Studies, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, 43600,Malaysia
- Corresponding author. Faculty of Social Sciences and Humanities Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia.
| | - Eugene Koh Boon Yau
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, 43400, Malaysia
| | - Abdul Rahman Ahmad Badayai
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, 43600, Malaysia
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The Efficacy of Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:147-157. [PMID: 36827194 DOI: 10.1097/ajp.0000000000001096] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/03/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Previous meta-analyses of a small number of trials showed that acceptance and commitment therapy (ACT) might improve chronic pain. Many new trials have been published afterward, and the factors that may impact the efficacy of ACT are less understood. We, therefore, conducted an updated systematic review with meta-analysis to investigate the efficacy of ACT for people with chronic pain. METHODS Randomized controlled trials that investigated the efficacy of ACT in clinical or community setting for adult populations with chronic pain were included. The methodological quality of trials was assessed with the Cochrane Risk of Bias tool. Standardized mean differences between ACT and comparison groups in their effects on 6 outcomes (ie, pain acceptance, quality of life, pain-related functioning, pain intensity, anxiety, and depression) were pooled across studies. RESULTS Of the 3171 records identified, 21 trials with 1962 participants were included for analysis. The comparison groups included active treatment and waitlist control/usual care. The standardized mean difference was 0.67 (95% CI: 0.48, 0.87) for pain acceptance, 0.43 (95% CI: 0.29, 0.57) for quality of life, -0.88 (95% CI: -1.14, -0.63) for pain-related functioning, -0.45 (95% CI: -0.62, -0.27) for pain intensity, -0.35 (95% CI: -0.54, -0.15) for anxiety, and -0.74 (95% CI, -0.98, -0.50) for depression, all favoring ACT. Subgroup analyses showed that the effects were statistically significant across almost all subgroups and for some outcomes were greater in the trials conducted in people with a specific diagnosis (as compared with those conducted in people with general chronic pain), the trials with waitlist or usual care control, the trials with a greater number of sessions of ACT, and the trials with a longer ACT intervention. DISCUSSION ACT is effective and comparable to, if not better than, some other available active treatments for chronic pain.
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Tunç H, Morris PG, Kyranides MN, McArdle A, McConachie D, Williams J. The relationships between valued living and depression and anxiety: A systematic review, meta-analysis, and meta-regression. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Fang S, Ding D. The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Braverman MT, Volmar KM, Govier DJ. "The Pain Doesn't Have to Control You." A Qualitative Evaluation of Three Pain Clinics Teaching Nonopioid Pain Management Strategies. Am J Health Promot 2023; 37:210-221. [PMID: 36053192 DOI: 10.1177/08901171221119799] [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: 01/19/2023]
Abstract
PURPOSE To explore factors related to effectiveness of nonpharmacological treatment for opioid-dependent patients suffering with chronic pain. APPROACH A qualitative study incorporating individual interviews and focus group interviews. SETTING 3 rural Oregon nonopioid pain management clinics. INTERVENTION A 10-week nonpharmacological educational program incorporating cognitive-behavioral therapy, movement therapy, mindfulness, and other skills. PARTICIPANTS AND METHODS Across sites, we conducted 9 individual interviews with clinic staff and 3 focus group interviews with 34 patients who had participated in the course. Thematic analysis was used to identify themes within and across respondent groups. RESULTS Analysis revealed 4 primary themes: program goals; program benefits; characteristics of patients who benefit from the program; coordination of clinic experiences with other care. Several primary findings can be highlighted. The clinics focused on improving patients' quality of life, while opioid use reduction was a potential secondary benefit, driven by patients. Major program benefits included enhanced pain self-management skills, patients' greater assertiveness in communications with healthcare providers, and, in numerous cases, opioid use reduction. Participants were unanimous that predisposition toward active self-management of one's pain was an essential factor for positive outcomes. Patients reported considerable variability in providers' understanding of their clinic participation. CONCLUSION Nonpharmacological approaches for treating chronic pain can be effective for many patients. Clinics teaching these approaches should be more fully integrated into the healthcare system.
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Affiliation(s)
- Marc T Braverman
- School of Social and Behavioral Health Sciences, 2694Oregon State University, Corvallis, OR, USA
| | - Karen M Volmar
- Department of Health Policy and Management, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana J Govier
- VA HSR&D Center to Improve Veteran Involvement in Care, Portland, OR, USA
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Hayes CJ, Gannon MA, Woodward EN, Long CR, George M, Ray-Griffith S, Tobey LR, Goree J. Implementation and Preliminary Effectiveness of a Multidisciplinary Telemedicine Pilot Initiative for Patients with Chronic Non-Cancer Pain in Rural and Underserved Areas at a Major Academic Medical Center. J Pain Res 2023; 16:55-69. [PMID: 36636266 PMCID: PMC9831086 DOI: 10.2147/jpr.s383212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
Background Arkansas lacks adequate access to high-quality pain care, as evidenced, in part, by it having the second highest opioid prescribing rate in the United States. To improve access to high-quality treatment of chronic pain, we developed the Arkansas Improving Multidisciplinary Pain Care and Treatment (AR-IMPACT) Telemedicine Clinic, a multidisciplinary and interprofessional team of specialists who provide evidence-based pain management for patients with chronic pain. Methods We conducted a single-arm pilot trial of the AR-IMPACT Telemedicine Clinic with rural, university-affiliated primary care clinics. We assessed the AR-IMPACT Telemedicine Clinic using an implementation framework and preliminary effectiveness measures. Specifically, we assessed 5 of the 8 implementation outcomes of the framework (ie, penetration, adoption, acceptability, appropriateness, and feasibility) using a mixed methods approach. To evaluate implementation outcomes, we used surveys, interviews, and administrative data. We used electronic health record data to measure preliminary effectiveness (ie, changes in average morphine milligram equivalents per day and pain and depression scores). Results The AR-IMPACT team saw 23 patients that were referred by 13 primary care physicians from three rural, university-affiliated primary care clinics over one year. Of the 19 patients willing to participate in the pilot study, 12 identified as women, 31.6% identified as Black, and over 50% had less than a bachelor's level education. Patients rated the clinic positively with high overall satisfaction. Referring physicians indicated high levels of appropriateness, acceptability, and feasibility of the program. AR-IMPACT team members identified several barriers and facilitators to the feasibility of implementing the program. No changes in preliminary effectiveness measures were statistically significant. Conclusion Overall, the AR-IMPACT Telemedicine Clinic obtained moderate penetration and adoption, was highly acceptable to patients, was highly acceptable and appropriate to providers, and was moderately feasible to providers and AR-IMPACT team members.
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Affiliation(s)
- Corey J Hayes
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA,Correspondence: Corey J Hayes, Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 782, Little Rock, AR, 72205, USA, Tel +501 526-8113, Email
| | - Matthew A Gannon
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, 72701, USA
| | - Eva N Woodward
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA,Center for Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Christopher R Long
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, 72701, USA
| | - Masil George
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Shona Ray-Griffith
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA,Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Leah R Tobey
- Center for Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Johnathan Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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Chronic pain acceptance: Relations to opioid misuse and pain management motives among individuals with chronic low back pain. Addict Behav 2023; 136:107495. [PMID: 36156453 PMCID: PMC10187546 DOI: 10.1016/j.addbeh.2022.107495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/02/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
The opioid epidemic is a significant public health concern, and opioid consumption rates and opioid-related deaths are on the rise. Chronic pain acceptance, or willingness to experience pain and pain-related distress, is one pain-related psychological mechanism that may reduce maladaptive attempts to avoid or control pain using opioids among individuals with chronic lower back pain (CLBP). However, little work has examined chronic pain acceptance as it relates to opioid use and motives for use among adults with CLBP. The current investigation sought to explore the effects of chronic pain acceptance on opioid misuse and motives for opioid use (i.e., pain management and coping motives) among adults with CLBP. Participants were 291 adults (69.1 % female, Mage = 45.77 years, SD = 11.22) self-reporting current mild to severe CLBP and current opioid use who were recruited via an online survey. Results indicated that higher acceptance of pain was related to lower levels of opioid misuse and lower motivation to use opioids to cope with pain. Contrary to hypotheses, chronic pain acceptance did not predict motivation to use opioids to cope with emotional distress (i.e., coping motives). The current findings provide support for chronic pain acceptance as a potential protective mechanism in terms of opioid misuse and motivation to use opioids to manage pain.
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Bakhshaie J, Penn TM, Doorley J, Pham TV, Greenberg J, Bannon S, Saadi A, Vranceanu AM. Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review. THE JOURNAL OF PAIN 2022; 23:1697-1711. [PMID: 35644442 DOI: 10.1016/j.jpain.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models - socioecological, cumulative stress, and biopsychosocial - related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP. PERSPECTIVE: This narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models - socioecological, cumulative stress, biopsychosocial -, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.
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Affiliation(s)
- Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Terence M Penn
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - James Doorley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Tony V Pham
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tulane Medical School, New Orleans, Louisiana; Duke University Global Health Master's Program, Durham, North Carolina
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Altaf Saadi
- Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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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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Lehinger E, Reed DE, McGeary DD, Hager BN, Roache JD. Impact of Chronic Pain and Perceived Opioid Benefit on Value Domains. J Clin Psychol Med Settings 2022; 29:689-698. [PMID: 35750972 DOI: 10.1007/s10880-022-09889-2] [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] [Accepted: 05/23/2022] [Indexed: 10/17/2022]
Abstract
Non-pharmacological chronic pain treatments increasingly incorporate values-based approaches as an alternative to opioid therapy. Chronic pain and opioid use may differentially impact value domains such as family or work, and there is little guidance on how to implement values-based treatment to address pain and comorbid opioid use. This study aims to characterize ways in which chronic pain and values interact. Participants (N = 327) 18 or older (M = 46 years) experiencing chronic musculoskeletal pain for > 3 months and actively taking a prescription opioid completed an online, self-report survey assessing the importance of values in six domains (i.e., family, intimate relationships, friendship, work, health, growth). Participants responded to questions about pain interference with and without opioids, and subjective impact of pain within each value domain. There were significant differences between the six value domains in importance ratings. Pain interference also differed among the values with the most reported pain interference occurring in the work and health domains. Pain interference without opioids was significantly greater for work, health, and family than the other values. The subjective impact of pain interference was greatest for family, work, and health as well. Across all value domains, pain interference without opioids was significantly greater than pain interference with the use of opioids. Results highlight that value domains are differentially impacted by chronic pain and opioids are perceived as reducing pain interference across all values. These results provide an initial description from which theory and hypotheses can be developed. Clinical implications and future directions are discussed.
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Affiliation(s)
- Elizabeth Lehinger
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA.
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, WA Puget Sound Health Care, Seattle, WA, USA
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brittany N Hager
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach. Pain Rep 2022; 7:e1019. [PMID: 36203645 PMCID: PMC9529058 DOI: 10.1097/pr9.0000000000001019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Literature on current treatments for chronic low back pain (cLBP) were reviewed and 4 interventions were recommended for inclusion in a multisite cLBP clinical trial. Introduction: Objective: Methods: Conclusion:
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Herbert MS, Tynan M, Lang AJ, Backhaus A, Casmar P, Golshan S, Afari N. An integrated mindfulness meditation and acceptance and commitment therapy intervention for chronic pain: Rationale, design, and methodology of a pilot randomized controlled trial of Acting with Mindfulness for Pain (AMP). Contemp Clin Trials 2022; 119:106809. [PMID: 35636734 DOI: 10.1016/j.cct.2022.106809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 12/29/2022]
Abstract
Acceptance and commitment therapy (ACT) is an evidence-based psychosocial intervention for chronic pain; however, in its present form ACT produces modest improvements in function and is no more effective than cognitive behavioral therapy (CBT), the current gold standard. This protocol paper describes the Acting with Mindfulness for Pain (AMP) protocol, which emphasizes and integrates formal mindfulness meditation practice within an ACT-based approach. This paper presents the rationale, design and methodology of an ongoing pilot randomized controlled trial (RCT) comparing AMP to CBT among Veterans with chronic pain (N = 86). Specifically, we argue that formal meditation practice is a necessary treatment component that directly targets key ACT processes which will help facilitate large treatment effects on function (e.g., general activity, social relationships, life enjoyment) among individuals with chronic pain. This study will be the first to consider formal mindfulness meditation practice as a principal treatment ingredient in the context of ACT for chronic pain. The purpose of this trial is to evaluate the feasibility of recruitment and collection of measures, and to examine preliminary treatment effects to determine the appropriateness of a subsequent full-scale RCT. This study will also explore within and between group change on primary and secondary outcomes including pain interference, pain acceptance, trait mindfulness, pain catastrophizing, values-based living, quality of life, practice adherence, and objective measures of physical activity. This study will help delineate the role of formal mindfulness practice within an ACT-based approach for chronic pain and provide preliminary data for a future fully powered RCT.
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Affiliation(s)
- Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
| | - Mara Tynan
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Ariel J Lang
- Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Autumn Backhaus
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Pollyanna Casmar
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Shahrokh Golshan
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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Ferreira MG, Mariano LI, Rezende JVD, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord 2022; 309:297-308. [PMID: 35489560 DOI: 10.1016/j.jad.2022.04.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors. METHODS Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). RESULTS The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30-0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31-0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited. LIMITATIONS The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results. CONCLUSION The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.
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Affiliation(s)
- Michele Gomes Ferreira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil
| | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Junio Vieira de Rezende
- Programa de Pós-Graduação em Psicologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, Caixa Postal N° 253, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil.
| | - Naoko Kishita
- School of Health Science, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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Castellano-Tejedor C. Non-Pharmacological Interventions for the Management of Chronic Health Conditions and Non-Communicable Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148536. [PMID: 35886388 PMCID: PMC9317682 DOI: 10.3390/ijerph19148536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Carmina Castellano-Tejedor
- Psynaptic, Psicología y Servicios Científicos y Tecnológicos S.L.P., 08192 Barcelona, Spain;
- GIES Research Group, Basic Psychology Department, Autonomous University of Barcelona, 08192 Barcelona, Spain
- Research Group on Aging, Frailty and Care Transitions in Barcelona (REFiT BCN), Parc Sanitari Pere Virgili & Vall d’Hebron Research Institute (VHIR), 08023 Barcelona, Spain
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46
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Kruger E, Ashworth J, Sowden G, Hickman J, Vowles KE. Profiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain. THE JOURNAL OF PAIN 2022; 23:1894-1903. [PMID: 35764256 DOI: 10.1016/j.jpain.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
Abstract
Pain acceptance and values-based action are relevant to treatment outcomes in those with chronic pain. It is unclear if patterns of responding in these two behavioral processes can be used to classify patients into distinct classes at treatment onset and used to predict treatment response. This observational cohort study had two distinct goals. First, it sought to classify patients at assessment based on pain acceptance and values-based action (N = 1746). Second, it sought to examine treatment outcomes based on class membership in a sub-set of patients completing an interdisciplinary pain rehabilitation program of Acceptance and Commitment Therapy for chronic pain (N = 343). Latent profile analysis was used in the larger sample to identify three distinct patient classes: low acceptance and values-based (AV) action (Low AV; n = 424), moderate acceptance and values-based action (Moderate AV; n = 983) and high acceptance and values-based action (High AV; n = 339). In the smaller treated sample, participants in the Low AV and Moderate AV class demonstrated improvements across all outcome variables, whereas those in the High AV class did not. These findings support the role of pain acceptance and values-based action in those with chronic pain.
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Affiliation(s)
- Eric Kruger
- The University of New Mexico Health Sciences Center, School of Medicine, Department of Orthopedics and Rehabilitation, Division of Physical Therapy.
| | - Julie Ashworth
- Impact Community Pain Service, Midlands Partnership Foundation NHS Trust; Primary Care Centre Versus Arthritis, School of Medicine, Keele University
| | - Gail Sowden
- School of Primary, Community & Social Care, Keele University; Connect Health, Newcastle upon Tyne
| | - Jayne Hickman
- UK Pain Service, Sandwell and West Birmingham Hospitals NHS Trust
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast & the Centre for Chronic Pain Rehabilitation, Belfast Health and Social Care Trust
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47
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Casey MB, Smart KM, Segurado R, Hearty C, Gopal H, Lowry D, Flanagan D, McCracken L, Doody C. Exercise combined with Acceptance and Commitment Therapy compared with a standalone supervised exercise programme for adults with chronic pain: a randomised controlled trial. Pain 2022; 163:1158-1171. [PMID: 34913883 DOI: 10.1097/j.pain.0000000000002487] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
ABSTRACT A prospective, 2-armed, parallel group randomised controlled trial (RCT) was conducted to compare the effectiveness of Acceptance and Commitment Therapy (ACT) combined with a supervised exercise programme with a supervised exercise programme alone for adults with chronic pain. One hundred seventy-five participants were individually randomised to receive either the combined Exercise and ACT (ExACT) intervention or supervised exercise alone. Those allocated to the ExACT group attended 8 weekly sessions with a psychologist based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group attended weekly supervised exercise classes but did not take part in an ACT programme. Both groups were followed up postintervention and again after 12 weeks. The primary outcome was pain interference at 12-week follow-up. Estimates of treatment effects at follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. The findings of this RCT showed no difference in the effectiveness of ExACT, compared with a supervised exercise programme alone for the primary outcome pain interference at 12-week follow-up (mean difference -0.18, 95% confidence interval -0.84 to 0.48, P = 0.59, d = 0.11). ExACT group participants reported superior outcomes for pain self-efficacy, pain catastrophising, and committed action, compared with the control group, but there were no differences between the groups for other secondary outcomes or treatment process measures. Higher levels of treatment satisfaction and global impression of change were reported by ExACT group participants. Exercise combined with Acceptance and Commitment Therapy was not superior to a standalone supervised exercise programme for reducing pain interference in adults with chronic pain.
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Affiliation(s)
- Máire-Bríd Casey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Keith M Smart
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hari Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Damien Lowry
- Department of Psychology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Dearbhail Flanagan
- Physiotherapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lance McCracken
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Catherine Doody
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
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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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You DS, Ziadni MS, Hettie G, Darnall BD, Cook KF, Von Korff MR, Mackey SC. Comparing Perceived Pain Impact Between Younger and Older Adults With High Impact Chronic Pain: A Cross-Sectional Qualitative and Quantitative Survey. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:850713. [PMID: 35465295 PMCID: PMC9030949 DOI: 10.3389/fpain.2022.850713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 01/19/2023]
Abstract
High impact chronic pain (HICP) is a recently proposed concept for treatment stratifying patients with chronic pain and monitoring their progress. The goal is to reduce the impact of chronic pain on the individual, their family, and society. The US National Pain Strategy defined HICP as the chronic pain associated with substantial restrictions on participation in work, social, and self-care activities for at least 6 months. To understand the meaning and characteristics of HICP from the younger (<65 years old) and older adults (≥65 years old) with chronic pain, our study examined patients' perceived pain impact between the two age groups. We also characterize the degree of pain impact, assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI), between adults and older adults with HICP. We recruited patients at a tertiary pain clinic. The survey included open-ended questions about pain impact, the Graded Chronic Pain Scale-Revised to identify patients' meeting criteria for HICP, and the Patient-Reported Outcomes Measurement Information System (PROMIS®) 8-item PI short form (v.8a). A total of 55 younger adults (65.5% women, 72.7% HICP, mean age = 55.0 with SD of 16.2) and 28 older adults (53.6% women, 64.3% HICP, mean age = 72.6 with SD of 5.4) with chronic pain participated in this study. In response to an open-ended question in which participants were asked to list out the areas of major impact pain, those with HICP in the younger group most commonly listed work, social activity, and basic physical activity (e.g., walking and standing); for those in the older group, basic physical activity, instrumental activity of daily living (e.g., housework, grocery shopping), and participating in social or fun activity for older adults with HICP were the most common. A 2 × 2 ANOVA was conducted using age (younger adults vs. older adults) and HICP classification (HICP vs. No HICP). A statistically significant difference was found in the PROMIS-PI T-scores by HICP status (HICP: M = 58.4, SD = 6.3; No HICP: M = 67.8, SD = 6.3), but not by age groups with HICP. In conclusion, perceived pain impacts were qualitatively, but not quantitatively different between younger and older adults with HICP. We discuss limitations and offer recommendations for future research.
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Affiliation(s)
- Dokyoung S. You
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maisa S. Ziadni
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gabrielle Hettie
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beth D. Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Michael R. Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sean C. Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States,*Correspondence: Sean C. Mackey
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50
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Johannsen M, Nissen ER, Lundorff M, O'Toole MS. Mediators of acceptance and mindfulness-based therapies for anxiety and depression A systematic review and meta-analysis. Clin Psychol Rev 2022; 94:102156. [DOI: 10.1016/j.cpr.2022.102156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022]
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