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Grinberg AS, Damush TM, Lindsey H, Burrone L, Baird S, Takagishi SC, Snyder I, Goldman RE, Sico JJ, Seng EK. The Headache Psychologists' Role in Pediatric and Adult Headache Care: A Qualitative Study of Expert Practitioners. J Clin Psychol Med Settings 2024; 31:359-367. [PMID: 37839060 PMCID: PMC11102355 DOI: 10.1007/s10880-023-09972-2] [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] [Accepted: 08/20/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We examined the perspectives of expert headache psychologists to inform best practices for integrating headache psychologists into the care of children and adults with headache disorders within medical settings. BACKGROUND Headache disorders are prevalent, chronic, and disabling neurological conditions. As clinical providers trained in evidence-based behavior change interventions with expertise in headache disorders, headache psychologists are uniquely positioned to provide behavioral headache treatment. METHODS In 2020, we conducted semi-structured interviews with a purposive sample of expert headache psychologists working across the United States. Open-ended questions focused on their roles, clinical flow, and treatment content. Interviews were audio-recorded, transcribed, de-identified, and analyzed using a rapid qualitative analysis method. RESULTS We interviewed seven expert headache psychologists who have worked for an average of 18 years in outpatient settings with pediatric (n = 4) and adult (n = 3) patients with headache. The themes that emerged across the clinical workflow related to key components of behavioral headache treatment, effective behavioral treatment referral practices, and barriers to patient engagement. The expert headache psychologists offered evidence-based behavioral headache interventions such as biofeedback, relaxation training, and cognitive behavioral therapy emphasizing lifestyle modification as standalone options or concurrently with pharmacological treatment and were of brief duration. Participants reported many of their patients appeared reluctant to seek behavioral treatment for headache. Participants believed referrals were most effective when the referring provider explained to the patient the rationale for behavioral treatment, treatment content, and positive impact on headache activity, functioning, and quality of life. Barriers cited by participants to integrating headache psychology into headache care included the paucity of psychologists with specialized headache training, lack of insurance reimbursement, limited patient time to seek behavioral treatment, and inadequate patient knowledge of what behavioral treatment entails. CONCLUSION Headache psychologists are often core members of multidisciplinary headache teams offering short-term, evidence-based behavioral interventions, both as a standalone treatment or in conjunction with pharmacotherapy. However, barriers to care persist. Enhancing referring providers' familiarity with psychologists' role in headache care may aid successful referrals for behavioral interventions for headache.
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Affiliation(s)
- Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, USA.
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA.
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA.
- VA Connecticut Healthcare System Headache Center of Excellence, National Programs Center-Mailing Code 689GF VA Annex, 200 Edison Road, Orange, CT, 06477, USA.
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Indiana University School of Medicine, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, USA
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA
| | - Laura Burrone
- VA Connecticut Healthcare System, West Haven, USA
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, USA
| | | | - Ivy Snyder
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, USA
| | - Roberta E Goldman
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Warren Alpert Medical School of Brown University, Providence, USA
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, USA
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA
- Yale School of Medicine, New Haven, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, USA
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Takagishi SC, Grinberg AS, Lindsey H, Goldman RE, Baird SA, Burrone L, Sico JJ, Damush TM. Headache Specialists' Perceptions of the Role of Health Psychologists in Headache Management: A Qualitative Study. Cureus 2024; 16:e56175. [PMID: 38618328 PMCID: PMC11015910 DOI: 10.7759/cureus.56175] [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] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background Since headache specialists cannot treat all the patients with headache disorders, multidisciplinary teams that include health psychologists are becoming more prevalent. Health psychologists mainly use a form of cognitive-behavioral therapy (CBT), along with biofeedback on occasion, to effectively address patients' pain and headache disorders. The Veterans Health Administration (VHA) is one setting that routinely includes a health psychologist with advanced training in pain disorders in their pain care to its veterans. The VHA has established Headache Centers of Excellence (HCoE) around the country to provide multidisciplinary treatment for patients with headache disorders, which enables headache specialists to regularly interact with health psychologists. Objective The study's objective is to evaluate headache specialists' views of health psychologists in the treatment of patients with headache disorders. Method Semi-structured interviews were conducted with headache specialists in academic-based healthcare settings, the community, and VHA HCoE sites. The interviews were audio-recorded and de-identified so they could be transcribed and analyzed using content matrix analysis. Results Four themes emerged: headache specialists desired to work with health psychologists and included them as members of multidisciplinary teams; valued health psychologists because they provided non-pharmacological treatments, such as CBT and biofeedback; preferred in-person communication with health psychologists; and used multiple titles when referring to health psychologists. Conclusion Headache specialists valued health psychologists as providers of behavioral and non-pharmacological treatments and considered them essential members of multidisciplinary teams. Headache specialists should strive to work with a headache psychologist, not just a general health psychologist. By committing to this, headache specialists can foster changes in the quality of care, resource allocation, and training experiences related to health psychologists.
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Affiliation(s)
- Stanley Curtis Takagishi
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Psychology, James A. Haley Veterans' Hospital, Tampa, USA
| | - Amy S Grinberg
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
| | - Hayley Lindsey
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
| | - Roberta E Goldman
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Anthropology & Family Medicine, Warren Alpert Medical School of Brown University, Providence, USA
- Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Sean A Baird
- Health Research & Development Service, Richard L. Roudebush VA (Veterans Affairs) Medical Center, Indianapolis, USA
| | - Laura Burrone
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
| | - Jason J Sico
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Neurology, Yale School of Medicine, New Haven, USA
| | - Teresa M Damush
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Health Research & Development Service, Richard L. Roudebush VA (Veterans Affairs) Medical Center, Indianapolis, USA
- Center for Health Services and Outcomes Research, Indiana University School of Medicine, Indianapolis, USA
- Center for Health Services and Outcomes Research, Regenstrief Institute, Inc., Indianapolis, USA
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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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Lyon RY, Schuster NM. Rate and Predictors of Patients with Chronic Pain Establishing Care with Pain Psychology Following Pain Physician Referral. PAIN MEDICINE 2023; 24:188-196. [PMID: 35861428 DOI: 10.1093/pm/pnac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine, among patients with chronic pain who had received pain physician referral to pain psychology, the rate of establishing care and factors related to establishing care with pain psychology. DESIGN Retrospective study. SETTING Academic tertiary care center. SUBJECTS Patients from the University of California, San Diego (UCSD) Center for Pain Medicine. METHODS This was an institutional review board-approved, retrospective study of 150 consecutive referrals of unique patients from UCSD Pain Medicine to UCSD Pain Psychology. RESULTS Of 150 patients referred to pain psychology, 74 (49.3%) established care with pain psychology. Of 98 patients who had previously seen mental health services, 58 established care with pain psychology (59.2%; 95% confidence interval [CI]: 49% to 69%), whereas of 52 patients who had not previously seen mental health services, 16 established care with pain psychology (30.8%; 95% CI: 18% to 43%) (odds ratio [OR] 3.26; 95% CI: 1.60 to 6.66). In the patient subset with depression and/or anxiety, of 82 patients who had previously seen mental health services, 47 established care with pain psychology (57.3%; 95% CI: 47% to 68%), whereas of 20 patients who had not previously seen mental health services, three established care with pain psychology (15%; 95% CI: -1% to 31%) (OR 7.61; 95% CI: 2.07 to 28.01). Of 96 patients referred for general pain psychology evaluations, 43 established care (45%; 95% CI: 35% to 55%), whereas of 38 patients referred for preprocedural evaluation for an implantable device, 24 established care (63%; 95% CI: 48% to 78%). CONCLUSION Patients are significantly more likely to establish care with pain psychology if they have previously seen a mental health professional. This was even more marked among the patient subset with a history of depression and/or anxiety who had engaged in mental health services than among those with a history of depression and/or anxiety who had not engaged in mental health services. Whether referral was for general psychological evaluation or preprocedural evaluation for an implantable device did not significantly influence whether patients established care. Targeted interventions are needed to improve the likelihood of patients engaging with pain psychology services.
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Affiliation(s)
- Ronit Y Lyon
- Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
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Kerns RD, Burgess DJ, Coleman BC, Cook CE, Farrokhi S, Fritz JM, Goertz C, Heapy A, Lisi AJ, Rhon DI, Vining R. Self-Management of Chronic Pain: Psychologically Guided Core Competencies for Providers. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1815-1819. [PMID: 35642906 PMCID: PMC9629397 DOI: 10.1093/pm/pnac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Robert D Kerns
- Department of Psychiatry
- Department of Neurology
- Department of Psychology, Yale University, New Haven, Connecticut
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Diana J Burgess
- VA Health Services Research and Development Service (HSR&D) Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Chad E Cook
- Departments of Orthopedics and Population Health Sciences, and the Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shawn Farrokhi
- Department of Defense–Department of Veterans Affairs (DOD-VA) Extremity Trauma and Amputation Center of Excellence and Naval Medical Center, San Diego, California
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, College of Health, The University of Utah, Salt Lake City, Utah
| | - Christine Goertz
- Department of Orthopaedics, Duke University School of Medicine, and Core Faculty Member, Duke-Margolis Center for Health Policy, Durham, North Carolina
| | - Alicia Heapy
- Department of Psychiatry
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Anthony J Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa, USA
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Molinari V, Edelstein B, Gibson R, Lind L, Norris M, O'Shea Carney K, Bush SS, Heck AL, Moye J, Gordon BH, Hiroto K. Psychologists in Long-Term Care (PLTC) Guidelines for Psychological and Behavioral Health Services in Long-Term Care Settings. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2021; 52:34-45. [PMID: 33867651 PMCID: PMC8052097 DOI: 10.1037/pro0000298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To address concerns about limited training of psychologists working in long-term care (LTC) facilities, the Psychologists in Long-Term Care (PLTC) organization published Standards for Psychological Services in Long-Term Care Facilities (Lichtenberg et al., 1998). The expanding evidence base for knowledge and skills, the increasing diversity of LTC residents, and the complexity of presenting problems have compounded the guidance psychologists need when providing services in this setting. In this article, the PLTC Guidelines Revision Task Force presents PLTC guidelines based on the original prescriptive PLTC Standards. The content of the PLTC Standards was updated and the format changed from prescriptive standards to aspirational guidelines. We begin with general guidelines regarding knowledge and skills in LTC (education and training. understanding of LTC systems. end-of-life care), followed by specific guidelines covering the basic psychological service activities in LTC (referral, assessment, treatment, ethical issues, and advocacy). The PLTC Guidelines are designed to provide direction for psychologists who work, or plan to work, in LTC and to guide continuing education pursuits.
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Affiliation(s)
| | | | - Robert Gibson
- Edgemoor Distinct Part Skilled Nursing facility, Santee, California
| | | | | | | | | | | | - Jennifer Moye
- Geriatric Research Education and Clinical Center, Bedford Massachusetts, and Harvard Medical School
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Pain Psychology for Surgeons and Otolaryngologists. Otolaryngol Clin North Am 2020; 53:885-895. [PMID: 32703691 DOI: 10.1016/j.otc.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pain is one of the leading reasons that brings patients into health care facilities; yet, it often is left undertreated. The biopsychosocial model of pain, which recognizes that pain is multidimensional, explains the complexities that affect the pain experience and response to treatment. Inclusion of behavioral and psychological factors in medical and surgical evaluations can facilitate an optimal outcome. When pain no longer is acute but becomes chronic, access to psychotherapeutic interventions becomes necessary to improve course and prognosis. Techniques, such as psychoeducation, deep breathing, imagery, and addressing expectations and catastrophic beliefs, can be incorporated into medical and surgical practices.
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