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Bérubé M, Verret M, Bourque L, Côté C, Guénette L, Richard-Denis A, Ouellet S, Singer LN, Gauthier L, Gagnon MP, Gagnon MA, Martorella G. Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review. Pain 2024:00006396-990000000-00630. [PMID: 38888742 DOI: 10.1097/j.pain.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
| | - Michael Verret
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada
| | - Simon Ouellet
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Lesley Norris Singer
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Lynn Gauthier
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
- Oncology Division, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Cancer Research Centre, Université Laval, Québec City, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, Tallahassee, FL, United States
- Florida State University Brain Science and Symptom Management Center, Tallahassee, FL, United States
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Pinto BM, Tavares I, Pozza DH. Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:686. [PMID: 38792869 PMCID: PMC11122846 DOI: 10.3390/medicina60050686] [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: 03/06/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. Materials and Methods: Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. Results: Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. Conclusions: This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.
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Affiliation(s)
- Beatriz Manarte Pinto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
| | - Isaura Tavares
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| | - Daniel Humberto Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
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Chen S, Gao X, Shi T, Zuo X, Hong C, Zhang Y, You B, Li F, Jackson T, He Y. Promising Subjective and Objective Benefits of Modified Mindfulness-Based Stress Reduction Training for Chinese Adults with Chronic Pain: A Pilot Randomized Control Study. Pain Ther 2023; 12:1397-1414. [PMID: 37713159 PMCID: PMC10615992 DOI: 10.1007/s40122-023-00551-9] [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: 06/27/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Mindfulness-based stress reduction (MBSR) has demonstrated its effectiveness in reducing pain-related stress in adults with chronic pain. However, the implementation of MBSR needs modifications across cultures. This pilot study reports the findings of a randomized controlled trial that investigated the effects of a culturally adaptive MBSR program on self-report and neuroimaging outcomes for chronic pain adults in China. METHODS Sixty-seven participants were randomly assigned to the treatment group (n = 40) or the treatment-as-usual group (n = 27) group at a ratio of 1.5:1. Participants completed self-report measures of pain severity, pain interference, depression, perceived stress, pain catastrophizing, mindfulness, and resilience at baseline assessment (T1), post-treatment (T2), and 3-month follow-up (T3) assessments. Functional magnetic resonance imaging (fMRI) scanning was also performed at T1 and T3 assessments. RESULTS For the intention-to-treat sample, the results of the mixed-effect model indicated that Group × Time interaction was significant for pain catastrophizing only (F (2, 130) = 3.51, p = 0.033). Compared with the control group, those in the MBSR group reported greater reductions in pain catastrophizing at T2 (d = - 0.60), though this effect was not maintained at T3 (d = - 0.05). Additionally, the results of completer analyses found significant Group × Time interactions for pain interference (F (2, 88) = 4.40, p = 0.015) and perceived stress (F (2, 88) = 3.13, p = 0.048), but not for other measures. Finally, both groups exhibited decreased regional homogeneity (ReHo) in the frontal lobe, while increased ReHo in the cerebellum anterior lobe was unique to the MBSR group. CONCLUSIONS The present findings suggest that the minor modified MBSR program improves certain pain-related outcomes for Chinese adults with chronic pain. Future studies with larger samples of Chinese chronic pain patients are needed to detect the small-to-moderate benefit of MBSR on fMRI and/or other objective methods.
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Affiliation(s)
- Shuanghong Chen
- Department of Medical Psychology, Neurological Medical Center, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, 400715, China
| | - Xubin Gao
- Department of Cardiology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Ting Shi
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, 400715, China
| | - Xibo Zuo
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, 400715, China
| | - Chengjin Hong
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, 400715, China
| | - Yaoyao Zhang
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, 400715, China
| | - Beibei You
- School of Nursing, Guizhou Medical University, Guiyang, 550025, China
| | - Fenghua Li
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, 400715, China
- School of Education, Henan University, Kaifeng, 475004, China
| | - Todd Jackson
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, 400715, China
- Department of Psychology, University of Macau, Taipa, 999078, Macau SAR
| | - Ying He
- Department of Medical Psychology, Neurological Medical Center, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
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Tsiouris A, Mayer A, Wiltink J, Ruckes C, Beutel ME, Zwerenz R. Recruitment of Patients With Cancer for a Clinical Trial Evaluating a Web-Based Psycho-Oncological Intervention: Secondary Analysis of a Diversified Recruitment Strategy in a Randomized Controlled Trial. JMIR Cancer 2023; 9:e42123. [PMID: 38010774 DOI: 10.2196/42123] [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: 08/23/2022] [Revised: 12/17/2022] [Accepted: 08/29/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Participant recruitment poses challenges in psycho-oncological intervention research, such as psycho-oncological web-based intervention studies. Strict consecutive recruitment in clinical settings provides important methodological benefits but is often associated with low response rates and reduced practicability and ecological validity. In addition to preexisting recruitment barriers, the protective measures owing to the COVID-19 pandemic restricted recruitment activities in the clinical setting since March 2020. OBJECTIVE This study aims to outline the recruitment strategy for a randomized controlled trial evaluating the unguided emotion-based psycho-oncological online self-help (epos), which combined traditional and web-based recruitment. METHODS We developed a combined recruitment strategy including traditional (eg, recruitment in clinics, medical practices, cancer counseling centers, and newspapers) and web-based recruitment (Instagram, Facebook, and web pages). Recruitment was conducted between May 2020 and September 2021. Eligible participants for this study were adult patients with any type of cancer who were currently receiving treatment or in posttreatment care. They were also required to have a good command of the German language and access to a device suitable for web-based interventions, such as a laptop or computer. RESULTS We analyzed data from 304 participants who were enrolled in a 17-month recruitment period using various recruitment strategies. Web-based and traditional recruitment strategies led to comparable numbers of participants (151/304, 49.7% vs 153/304, 50.3%). However, web-based recruitment required much less effort. Regardless of the recruitment strategy, the total sample did not accurately represent patients with cancer currently undergoing treatment for major types of cancer in terms of various sociodemographic characteristics, including but not limited to sex and age. However, among the web-recruited study participants, the proportion of female participants was even higher (P<.001), the mean age was lower (P=.005), private internet use was higher (on weekdays: P=.007; on weekends: P=.02), and the number of those who were currently under treatment was higher (P=.048). Other demographic and medical characteristics revealed no significant differences between the groups. The majority of participants registered as self-referred (236/296, 79.7%) instead of having followed the recommendation of or study invitation from a health care professional. CONCLUSIONS The combined recruitment strategy helped overcome general and COVID-19-specific recruitment barriers and provided the targeted participant number. Social media recruitment was the most efficient individual recruitment strategy for participant enrollment. Differences in some demographic and medical characteristics emerged, which should be considered in future analyses. Implications and recommendations for social media recruitment based on personal experiences are presented. TRIAL REGISTRATION German Clinical Trials Register DRKS00021144; https://drks.de/search/en/trial/DRKS00021144. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.invent.2021.100410.
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Affiliation(s)
- Angeliki Tsiouris
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Anna Mayer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Galvez-Sánchez CM, Montoro CI. Psychoeducation for Fibromyalgia Syndrome: A Systematic Review of Emotional, Clinical and Functional Related-Outcomes. Behav Sci (Basel) 2023; 13:bs13050415. [PMID: 37232652 DOI: 10.3390/bs13050415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Fibromyalgia Syndrome (FMS) is a chronic condition of widespread pain accompanied by several symptoms such as stiffness, fatigue, sleep problems, depression, anxiety, and cognitive deficits. To date, there is no specific treatment for FMS. The European League Against Rheumatism, and the majority of the international recommendations for managing FMS, has claimed psychoeducational intervention as the first step in FMS treatment for adequate symptoms management. However, scientific studies in this regard are scarce, diverse, and with contradictory findings. Results integration from analogous studies could provide a clear presentation of the real clinical value of psychoeducation in FMS. Therefore, the current systematic review aims at exploring the effect of psychoeducation on emotional, clinical, and functional symptoms of FMS patients and encourages researchers towards psychoeducation's procedure optimization and systematization. The systematic review was conducted according to the guidelines of the Cochrane Collaboration and PRISMA statements. The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The selected articles were extracted from PubMed, Scopus, and Web of Science databases. The literature search identified 11 studies eligible for the systematic review. The ROB evaluation revealed that 2 of the 11 studies showed a low quality, the other 2 had a moderate quality, and the remaining 7 studies exhibited a high quality. Results showed that psychoeducation is generally included as an important first therapeutic step in multicomponent treatments for FMS. Moreover, psychoeducation generally seems to be quite beneficial in reducing emotional (i.e., number of days feeling emotionally well, general anxiety, depression levels, etc.) and clinical symptoms (levels of fatigue, morning stiffness, pain intensity, etc.), as well as increasing functional status (i.e., general physical function, morning fatigue, stiffness, etc.). Despite that psychoeducation´s clinical benefits are highlighted, there is scarce amount of research on psychoeducation beyond its usefulness as part of multicomponent treatments.
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Tao TJ, Lim TK, Yeung ETF, Liu H, Shris PB, Ma LKY, Lee TMC, Hou WK. Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:80. [PMID: 37117458 PMCID: PMC10141870 DOI: 10.1038/s41746-023-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
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Affiliation(s)
- Tiffany Junchen Tao
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Teck Kuan Lim
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ernest Tsun Fung Yeung
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoenix Bibha Shris
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Ka Yin Ma
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China.
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Hunt CA, Letzen JE, Krimmel SR, Burrowes SAB, Haythornthwaite JA, Keaser M, Reid M, Finan PH, Seminowicz DA. Meditation Practice, Mindfulness, and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine. Mindfulness (N Y) 2023; 14:769-783. [PMID: 38435377 PMCID: PMC10907069 DOI: 10.1007/s12671-023-02105-8] [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] [Accepted: 03/04/2023] [Indexed: 04/07/2023]
Abstract
Objectives Mindfulness-based interventions (MBIs) have emerged as promising prophylactic episodic migraine treatments. The present study investigated biopsychosocial predictors and outcomes associated with formal, daily-life meditation practice in migraine patients undergoing MBI, and whether augmented mindfulness mechanistically underlies change. Methods Secondary analyses of clinical trial data comparing a 12-week enhanced mindfulness-based stress reduction course (MBSR + ; n = 50) to stress management for headache (SMH; n = 48) were conducted. Results Pre-treatment mesocorticolimbic system functioning (i.e., greater resting state ventromedial prefrontal cortex-right nucleus accumbens [vmPFC-rNAC] functional connectivity) predicted greater meditation practice duration over MBSR + (r = 0.58, p = 0.001), as well as the change in headache frequency from pre- to post-treatment (B = -12.60, p = 0.02) such that MBSR + participants with greater vmPFC-rNAC connectivity showed greater reductions in headache frequency. MBSR + participants who meditated more showed greater increases in mindfulness (B = 0.52, p = 0.02) and reductions in the helplessness facet of pain catastrophizing (B = -0.13, p = 0.01), but not headache frequency, severity, or impact. Augmented mindfulness mediated reductions in headache impact resulting from MBSR + , but not headache frequency. Conclusions Mesocorticolimbic system function is implicated in motivated behavior, and thus, motivation-enhancing interventions might be delivered alongside mindfulness-based training to enhance meditation practice engagement. Formal, daily-life meditation practice duration appears to benefit pain-related cognitions, but not clinical pain, while mindfulness emerges as a mechanism of MBIs on headache impact, but not frequency. Further research is needed to investigate the day-to-day effects of formal, daily-life meditation practice on pain, and continue to characterize the specific mechanisms of MBIs on headache outcomes. Preregistration This study is not preregistered.
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Affiliation(s)
- Carly A. Hunt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Virginia, VA, Charlottesville, USA
| | - Janelle E. Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samuel R. Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shana A. B. Burrowes
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02218, USA
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Matthew Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick H. Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Virginia, VA, Charlottesville, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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8
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Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
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9
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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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10
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Bäuerle A, Martus P, Erim Y, Schug C, Heinen J, Krakowczyk JB, Steinbach J, Damerau M, Bethge W, Dinkel A, Dries S, Mehnert-Theuerkauf A, Neumann A, Schadendorf D, Tewes M, Wiltink J, Wünsch A, Zipfel S, Graf J, Teufel M. Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct. BMJ Open 2022; 12:e056973. [PMID: 35649607 PMCID: PMC9161102 DOI: 10.1136/bmjopen-2021-056973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Many patients with cancer experience severe psychological distress, but as a result of various barriers, few of them receive psycho-oncological support. E-mental health interventions try to overcome some of these barriers and the limitation of healthcare offers, enabling patients with cancer to better cope with psychological distress. In the proposed trial, we aim to assess the efficacy and cost-effectiveness of the manualised e-mental health intervention Make It Training- Mindfulness-Based and Skills-Based Distress Reduction in Oncology. Make It Training is a self-guided and web-based psycho-oncological intervention, which includes elements of cognitive behavioural therapy, mindfulness-based stress reduction and acceptance and commitment therapy. The training supports the patients over a period of 4 months. We expect the Make It Training to be superior to treatment as usual optimised (TAU-O) in terms of reducing distress after completing the intervention (T1, primary endpoint). METHODS AND ANALYSIS The study comprises a multicentre, prospective, randomised controlled confirmatory interventional trial with two parallel arms. The proposed trial incorporates four distinct measurement time points: the baseline assessment before randomisation, a post-treatment assessment and 3 and 6 month follow-up assessments. We will include patients who have received a cancer diagnosis in the past 12 months, are in a curative treatment setting, are 18-65 years old, have given informed consent and experience high perceived psychological distress (Hospital Anxiety and Depression Scale ≥13) for at least 1 week. Patients will be randomised into two groups (Make It vs TAU-O). The aim is to allocate 600 patients with cancer and include 556 into the intention to treat analysis. The primary endpoint, distress, will be analysed using a baseline-adjusted ANCOVA for distress measurement once the intervention (T1) has been completed, with study arm as a binary factor, baseline as continuous measurement and study centre as an additional categorical covariate. ETHICS AND DISSEMINATION The Ethics Committee of the Medical Faculty Essen has approved the study (21-10076-BO). Results will be published in peer-reviewed journals, conference presentations, the project website, and among self-help organisations. TRIAL REGISTRATION NUMBER German Clinical Trial Register (DRKS); DRKS-ID: DRKS00025213.
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Affiliation(s)
- Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biostatistics, Eberhard Karls University Tübingen, University Hospital Tübingen, Tübingen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Jana Heinen
- Department of Psychosomatic Medicine and Psychotherapy, Eberhard Karls University, University Hospital Tübingen, Tübingen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Tübingen, Tübingen-Stuttgart, Germany
| | - Julia Barbara Krakowczyk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
| | - Jasmin Steinbach
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
| | - Mirjam Damerau
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
| | - Wolfgang Bethge
- Centre of Clinical Trials (ZKS) Tübingen, Eberhard Karls University Tübingen, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, München, Germany
| | - Sebastian Dries
- Healthcare Department, Fraunhofer Institute for Software and Systems Engineering (ISST), Dortmund, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Neumann
- Institute of Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
- Department of Dermatology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Mitra Tewes
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
- Department of Medical Oncology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander Wünsch
- Clinic for Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Freiburg Medical Center, Freiburg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Eberhard Karls University, University Hospital Tübingen, Tübingen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Tübingen, Tübingen-Stuttgart, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, Eberhard Karls University, University Hospital Tübingen, Tübingen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Tübingen, Tübingen-Stuttgart, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
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11
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Mindfulness-Enhanced Computerized Cognitive Training for Depression: An Integrative Review and Proposed Model Targeting the Cognitive Control and Default-Mode Networks. Brain Sci 2022; 12:brainsci12050663. [PMID: 35625049 PMCID: PMC9140161 DOI: 10.3390/brainsci12050663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Depression is often associated with co-occurring neurocognitive deficits in executive function (EF), processing speed (PS) and emotion regulation (ER), which impact treatment response. Cognitive training targeting these capacities results in improved cognitive function and mood, demonstrating the relationship between cognition and affect, and shedding light on novel targets for cognitive-focused interventions. Computerized cognitive training (CCT) is one such new intervention, with evidence suggesting it may be effective as an adjunct treatment for depression. Parallel research suggests that mindfulness training improves depression via enhanced ER and augmentation of self-referential processes. CCT and mindfulness training both act on anti-correlated neural networks involved in EF and ER that are often dysregulated in depression—the cognitive control network (CCN) and default-mode network (DMN). After practicing CCT or mindfulness, downregulation of DMN activity and upregulation of CCN activity have been observed, associated with improvements in depression and cognition. As CCT is posited to improve depression via enhanced cognitive function and mindfulness via enhanced ER ability, the combination of both forms of training into mindfulness-enhanced CCT (MCCT) may act to improve depression more rapidly. MCCT is a biologically plausible adjunct intervention and theoretical model with the potential to further elucidate and target the causal mechanisms implicated in depressive symptomatology. As the combination of CCT and mindfulness has not yet been fully explored, this is an intriguing new frontier. The aims of this integrative review article are four-fold: (1) to briefly review the current evidence supporting the efficacy of CCT and mindfulness in improving depression; (2) to discuss the interrelated neural networks involved in depression, CCT and mindfulness; (3) to present a theoretical model demonstrating how MCCT may act to target these neural mechanisms; (4) to propose and discuss future directions for MCCT research for depression.
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12
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Liu Z, Jia Y, Li M, Meng X, Shang B, Wang C, Chen L. Effectiveness of online mindfulness-based interventions for improving mental health in patients with physical health conditions: Systematic review and meta-analysis. Arch Psychiatr Nurs 2022; 37:52-60. [PMID: 35337439 DOI: 10.1016/j.apnu.2021.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/19/2021] [Accepted: 10/03/2021] [Indexed: 12/18/2022]
Abstract
We aimed to determine the effectiveness of online mindfulness-based interventions (MBIs) for improving mental health in patients with physical health conditions. Randomized controlled trials (RCTs) in PubMed, Cochrane Library, Web of Science, Elsevier, and CINAHL published through September 2019 were searched. Two reviewers selected trials, conducted a critical appraisal, and extracted the data. Meta-analyses were performed. A total of nine RCTs were included. Analyses revealed that online MBIs was effective in improving depression [standardized mean difference (SMD) = -0.22, 95% confidence interval (CI) (-0.37, -0.07), p = 0.004], anxiety [SMD = -0.19, 95% CI (-0.33, -0.04), p = 0.01], and stress [SMD = -0.32, 95% CI (-0.52, -0.13), p = 0.001], and mindfulness [SMD = 1.67, 95% CI (0.14, 3.20), p = 0.03] in patients with physical conditions. We did not find any obvious effects on well-being [SMD = 1.12, 95% CI (-0.11, 2.36), p = 0.08]. Nevertheless, additional well-designed randomized clinical trials are further needed.
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Affiliation(s)
- Zengxia Liu
- School of Nursing, Jilin University, Changchun, China; School of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Yong Jia
- School of Nursing, Jilin University, Changchun, China
| | - Min Li
- Invasive Technology Department, First Hospital of Jilin University, Changchun, China
| | - Xiangfei Meng
- School of Nursing, Jilin University, Changchun, China
| | - Binghan Shang
- School of Nursing, Jilin University, Changchun, China
| | - Chunyan Wang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, Changchun, China.
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China.
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13
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Reuman L, Solar C, MacLean RR, Halat AM, Rajeevan H, Williams DA, Heapy AA, Bair MJ, Krein SL, Kerns RD, Higgins DM. If you personalize it, will they use it?: Self-reported and observed use of a tailored, internet-based pain self-management program. Transl Behav Med 2022; 12:693-701. [PMID: 35192703 PMCID: PMC9154266 DOI: 10.1093/tbm/ibab165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Little is known about how individuals with chronic pain use tailored internet-based interventions. This study is the first to compare self-reported skill module use to observed module access and to examine each of these in relationship to tailored recommendations to access specific content. Participants (N = 58) enrolled in a 10-week trial of the Pain EASE program, a tailored internet-based intervention that includes 10 pain self-management skill modules. Participants completed a "Self-Assessment," which was used to provide a "Personalized Plan" that encouraged accessing specific modules. Participants self-reported module use during weekly data collection telephone calls. Program log data were extracted to capture "observed" module use during the trial period. Findings indicated significantly greater self-reported use of the Pain EASE modules compared to observed access with log data. Further, log data revealed that participants accessed less than half of the modules recommended to them via tailoring.
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Affiliation(s)
- Lillian Reuman
- VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
| | | | - R Ross MacLean
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA,Yale School of Medicine, New Haven, CT, USA
| | | | | | | | - Alicia A Heapy
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA,Yale School of Medicine, New Haven, CT, USA
| | - Matthew J Bair
- VA Center for Health Information and Communication (CHIC), Indianapolis, IN, USA,Indiana University School of Medicine, Indianapolis, IN, USA,Regenstrief Institute, Indianapolis, IN, USA
| | - Sarah L Krein
- University of Michigan Medical School, Ann Arbor, MI, USA,VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA,Yale School of Medicine, New Haven, CT, USA
| | - Diana M Higgins
- VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA,Correspondence to: DM Higgins, ,
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14
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O’Reilly PM, Harney OM, Hogan MJ, Mitchell C, McGuire BE, Slattery B. Chronic pain self-management in middle-aged and older adults: A collective intelligence approach to identifying barriers and user needs in eHealth interventions. Digit Health 2022; 8:20552076221105484. [PMID: 35694121 PMCID: PMC9185015 DOI: 10.1177/20552076221105484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives eHealth refers to health services and health information delivered or
enhanced through the internet and related technologies. The number of
eHealth interventions for chronic pain self-management is increasing.
However, little evidence has been found for the overall efficacy of these
interventions for older adults. The aim of the current study was to use a
Collective Intelligence approach to identify the barriers and specific user
needs of middle-aged and older adults using eHealth for chronic pain
self-management. Methods A Collective Intelligence workshop was conducted with middle-aged and older
adults to generate, clarify, select, and structure ideas in relation to
barriers to eHealth use and specific design requirements for the purposes of
chronic pain self-management. Prior to attending the workshop, participants
received a trigger question requesting the identification of five barriers
to eHealth use for chronic pain self-management. These barriers were
categorised and presented to the group along with barrier-related scenarios
and user need prompts, resulting in the generation of a set of ranked
barriers and a set of user needs. Results A total of 78 barriers were identified, from which six categories emerged:
Content, Support, Technological, Personal, Computer Literacy and
Accessibility. Additional idea-writing and group reflection in response to
these barriers revealed 97 user needs. Conclusion This is the first study to use Collective Intelligence methods to investigate
barriers to eHealth technology use and the specific user needs of
middle-aged and older adults in the context of chronic pain self-management.
The results of the current study provide a platform for the design and
development of enhanced eHealth interventions for this population.
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Affiliation(s)
- Paul M O’Reilly
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Owen M Harney
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Michael J Hogan
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Caroline Mitchell
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospital, Galway, Ireland
| | - Brian E McGuire
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospital, Galway, Ireland
| | - Brian Slattery
- School of Psychology, Dublin City University, Dublin, Ireland
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15
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Heinen J, Bäuerle A, Schug C, Krakowczyk JB, Strunk SE, Wieser A, Beckord J, Jansen C, Dries S, Pantförder M, Erim Y, Zipfel S, Mehnert-Theuerkauf A, Wiltink J, Wünsch A, Dinkel A, Stengel A, Kruse J, Teufel M, Graf J. Mindfulness and skills-based eHealth intervention to reduce distress in cancer-affected patients in the Reduct trial: Intervention protocol of the make it training optimized. Front Psychiatry 2022; 13:1037158. [PMID: 36387004 PMCID: PMC9650647 DOI: 10.3389/fpsyt.2022.1037158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Cancer-affected patients experience high distress due to various burdens. One way to expand psycho-oncological support is through digital interventions. This protocol describes the development and structure of a web-based psycho-oncological intervention, the Make It Training optimized. This intervention is currently evaluated in the Reduct trial, a multicenter randomized controlled trial. METHODS The Make It Training optimized was developed in six steps: A patient need and demand assessment, development and acceptability analysis of a prototype, the formation of a patient advisory council, the revision of the training, implementation into a web app, and the development of a motivation and evaluation plan. RESULTS Through a process of establishing cancer-affected patients' needs, prototype testing, and patient involvement, the Make It Training optimized was developed by a multidisciplinary team and implemented in a web app. It consists of 16 interactive self-guided modules which can be completed within 16 weeks. DISCUSSION Intervention protocols can increase transparency and increase the likelihood of developing effective web-based interventions. This protocol describes the process and results of developing a patient-oriented intervention. Future research should focus on the further personalization of web-based psycho-oncological interventions and the potential benefits of combining multiple psychotherapeutic approaches.
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Affiliation(s)
- Jana Heinen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.,Comprehensive Cancer Center (CCC-TS), University Hospital Tübingen, Tübingen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.,Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Barbara Krakowczyk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.,Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
| | - Sven Erik Strunk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Wieser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.,Comprehensive Cancer Center (CCC-TS), University Hospital Tübingen, Tübingen, Germany
| | - Jil Beckord
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.,Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
| | - Christoph Jansen
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.,Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
| | - Sebastian Dries
- Fraunhofer Institute for Software and Systems Engineering (ISST), Dortmund, Germany
| | - Michael Pantförder
- Fraunhofer Institute for Software and Systems Engineering (ISST), Dortmund, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.,Comprehensive Cancer Center (CCC-TS), University Hospital Tübingen, Tübingen, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander Wünsch
- Clinic for Psychosomatic Medicine and Psychotherapy, Freiburg Medical Center, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.,Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.,Comprehensive Cancer Center (CCC-TS), University Hospital Tübingen, Tübingen, Germany.,Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Johannes Kruse
- Department of Psychotherapy and Psychosomatics, Justus Liebig University Giessen, Giessen, Germany.,Department of Psychotherapy and Psychosomatics, Philipps University Marburg, Marburg, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.,Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.,Comprehensive Cancer Center (CCC-TS), University Hospital Tübingen, Tübingen, Germany
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16
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Krane NA, Simmons JK, Sykes KJ, Kriet JD, Humphrey CD. Guided Mindfulness Meditation for Pain Control After Septorhinoplasty: A Randomized-Controlled Pilot Study. Facial Plast Surg Aesthet Med 2021; 24:111-116. [PMID: 34861125 DOI: 10.1089/fpsam.2021.0184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Mindfulness meditation has been shown to alleviate pain and may be an appealing adjunctive pain management option. Objective: To compare measures of pain, mindfulness, and opioid usage, and collect evaluative feedback among patients undergoing septorhinoplasty with and without guided meditation. Methods: Patients undergoing septorhinoplasty were randomized to online-guided meditation postoperative days 0-3 versus standard care; all received the same pain medications. Primary outcome measures included pain intensity, opioid consumption, mindfulness scores, and evaluative feedback. Results: Twenty-one patients received guided meditation and 24 received standard care. No significant difference in opioid consumption or pain scores was seen with the exception of higher opioid use in patients with intranasal splints in the standard care group. Twenty out of 21 patients provided evaluative feedback; all recommended mindfulness meditation to friends undergoing nasal surgery, 90% reported it was beneficial, 85% believed it eased pain/discomfort, and 80% believed it aided with sleep. Conclusion: Although no objective difference was found in opioid consumption or pain scores, most patients reported that guided mindfulness meditation was beneficial to their recovery following septorhinoplasty.
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Affiliation(s)
- Natalie A Krane
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - J Kai Simmons
- Department of Otolaryngology - Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Kevin J Sykes
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - J David Kriet
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Clinton D Humphrey
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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17
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Sommers-Spijkerman M, Austin J, Bohlmeijer E, Pots W. New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials. JMIR Ment Health 2021; 8:e28168. [PMID: 34279240 PMCID: PMC8329762 DOI: 10.2196/28168] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. OBJECTIVE This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. METHODS We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. RESULTS The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. CONCLUSIONS Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.
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Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judith Austin
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Wendy Pots
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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18
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021; 5:631-652. [PMID: 33875837 DOI: 10.1038/s41562-021-01093-w] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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Martin A, Chopra R, Nicassio PM. Nonpharmacologic Pain Management in Inflammatory Arthritis. Rheum Dis Clin North Am 2021; 47:277-295. [PMID: 33781495 DOI: 10.1016/j.rdc.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article provides an overview of nonpharmacologic options for the treatment of pain in patients with inflammatory arthritis, such as peripheral spondyloarthritis, psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis. The experience of pain in chronic disease is a complex process influenced by multiple domains of health. The discussion focuses on the establishment of a framework for pain control that engages with factors that influence the experience of pain and explores the evidence base that supports specific modalities of nonpharmacologic pain control, such as mindfulness, cognitive behavioral therapy, exercise, massage, splinting, and heat therapy. Rheumatoid and spondyloarthritides are considered separately.
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Affiliation(s)
- Alexander Martin
- Division of Rheumatology, UMass Medical School, 119 Belmont Street, Worcester, MA 01605, USA
| | - Ratnesh Chopra
- Division of Rheumatology, UMass Medical School, 119 Belmont Street, Worcester, MA 01605, USA.
| | - Perry M Nicassio
- Department of Psychiatry, UCLA, 760 Westwood Plaza, C9-402, Los Angeles, CA 90095, USA
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20
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Světlák M, Linhartová P, Knejzlíková T, Knejzlík J, Kóša B, Horníčková V, Jarolínová K, Lučanská K, Slezáčková A, Šumec R. Being Mindful at University: A Pilot Evaluation of the Feasibility of an Online Mindfulness-Based Mental Health Support Program for Students. Front Psychol 2021; 11:581086. [PMID: 33505332 PMCID: PMC7829670 DOI: 10.3389/fpsyg.2020.581086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022] Open
Abstract
University study can be a life period of heightened psychological distress for many students. The development of new preventive and intervention programs to support well-being in university students is a fundamental challenge for mental health professionals. We designed an 8-week online mindfulness-based program (eMBP) combining a face-to-face approach, text, audio, video components, and support psychotherapy principles with a unique intensive reminder system using the Facebook Messenger and Slack applications in two separate runs (N = 692). We assessed the program's effect on mindful experiencing, perceived stress, emotion regulation strategies, self-compassion, negative affect, and quality of life. The results of the presented pilot study confirmed that eMBP is a feasible and effective tool in university students' mental health support. The students who completed the eMBP reported a reduction of perceived stress with a large effect size ( p η2 = 0.42) as well as a decrease of negative affect experience frequency and intensity ( p η2 = 0.31), an increase of being mindful in their life (Five Facet Mindfulness Questionnaire subscales: p η2 = 0.21, 0.27, 0.25, 0.28, 0.28), and a higher rate of self-compassion ( p η2 = 0.28) with a medium effect size. A small effect size was found in the frequency of using a cognitive reappraisal strategy ( p η2 = 0.073). One new result is the observation of an eMBP effect ( p η2 = 0.27) on the decrease in attributed importance to the quality-of-life components replicated in two consecutive runs of the program. The study affirms that mindfulness-based interventions can be effectively delivered in an eHealth form to university students.
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Affiliation(s)
- Miroslav Světlák
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Terezia Knejzlíková
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jakub Knejzlík
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Barbora Kóša
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Veronika Horníčková
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Kristýna Jarolínová
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Klaudia Lučanská
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Alena Slezáčková
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Rastislav Šumec
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia.,First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
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21
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Ngamkham S, Yang JJ, Smith EL. Thai Buddhism-Based Mindfulness for Pain Management in Thai Outpatients with Cancer: A Pilot Study. Asia Pac J Oncol Nurs 2021; 8:58-67. [PMID: 33426191 PMCID: PMC7785079 DOI: 10.4103/apjon.apjon_43_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate Thai Buddhism-based Mindfulness (TBbM) feasibility based on recruitment and retention rates and to obtain preliminary data regarding changes (effect sizes) in pain severity and other outcomes when comparing control to intervention participants following TBbM use. METHODS A randomized controlled trial was conducted in the Outpatient Department at Sawanpracharak Hospital, Thailand, from April 2018 to February 2019. Seventeen participants completed the pretest and posttest. Both groups (control group [n = 10] and intervention group [n = 7]) received usual care and watched a 25-min educational video about cancer pain. The intervention group participated in a 3-day mindfulness training program at a Buddhist temple and continued practicing at home for 8 weeks. Data were collected at baseline and at 1 and 2 months postintervention. RESULTS One-hundred and thirty-five participants met the eligibility criteria; 112 (82%) declined to participate and 6 of 23 (26%) were lost to follow-up/dropped out. Control and intervention participants had an average age of 44 (± 8.77) and 56 years (± 7.41), respectively. When compared to the control group, the TBbM participants reported no statistically significant improvements in pain or other outcomes. While not statistically significant, the effect size indicated that pain did improve in the TBbM group (Cohen's d = 0.41). CONCLUSIONS Given the suboptimal recruitment and retention rates, modification of the intervention is warranted. Further, our findings suggest that the intervention had a moderate effect on pain. To evaluate efficacy, future adequately powered studies are needed to test a more feasible TBbM intervention.
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Affiliation(s)
- Srisuda Ngamkham
- Department of Fundamental Nursing and Nursing Administration, Boromarajonani College of Nursing Sawanpracharak Nakhonsawan, Nakhonsawan, Thailand
| | - James J. Yang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ellen Lavoie Smith
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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22
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Pei JH, Ma T, Nan RL, Chen HX, Zhang YB, Gou L, Dou XM. Mindfulness-Based Cognitive Therapy for Treating Chronic Pain A Systematic Review and Meta-analysis. PSYCHOL HEALTH MED 2020; 26:333-346. [PMID: 33241941 DOI: 10.1080/13548506.2020.1849746] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic pain is a significant public health problem with emotional and disabling factors, which may not completely respond to current medical treatments such as opioids. The systematic review and meta-analysis aimed to examine the effectiveness and safety of MBCT for patients with chronic pain. Database searches of PubMed, Medline, EMBASE, the Cochrane Library, PsycINFO, Web of Science, Scopus and CINAHL up to 15 October 2019. Included studies assessed with the Cochrane risk-of-bias tool. Eight RCTs involved 433 patients, including chronic low back pain, fibromyalgia, migraine, rheumatoid arthritis and mix etiology. MBCT intervention demonstrated a short-term improvement on depression mood [standardized mean difference -0.72; 95% confidence interval = -1.22 to -0.22, p = 0.005] compared with usual care and was associated with short-term improvement in mindfulness compared with non-MBCT [SMD 0.51; 95% CI = 0.01 to 1.01, p = 0.04]. Between-group differences in pain intensity, pain inference and pain acceptance were not significant at short- or long-term follow-up. Compared to active treatments, MBCT intervention not found significant differences in either short- or long-term outcomes. MBCT showed short-term efficacious on depressed mood and mindfulness of chronic pain patients. Longer follow-ups, large sample and rigorous RCTs that can be best understand remaining uncertainties needed.
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Affiliation(s)
- Ju-Hong Pei
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Tong Ma
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Rui-Lin Nan
- Department of Spine Minimally Invasive Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Hai-Xia Chen
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Ya-Bin Zhang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Lin Gou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xin-Man Dou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China.,Department of EICU, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
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23
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Systematic scoping review of interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: current evidence and future directions. Pain Rep 2020; 5:e868. [PMID: 33251471 PMCID: PMC7690768 DOI: 10.1097/pr9.0000000000000868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/29/2020] [Accepted: 09/22/2020] [Indexed: 01/17/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. None of the mindfulness-based clinical trials for chronic pain included in this review analyzed the interaction effects between mindfulness interventions and concomitant analgesic drug therapies. Most patients with chronic pain do not find adequate pain relief with a single treatment, and accumulating evidence points to the added benefits of rational combinations of different treatments. Given that psychological therapies, such as mindfulness-based interventions (MBIs), are often delivered in conjunction with concomitant analgesic drug therapies (CADTs), this systematic scoping review examines the evidence for any interactions between MBIs and CADTs. The protocol for this review has been published and registered. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and PsycINFO databases were searched until July 2019. We included randomized controlled trials that evaluated the efficacy of MBIs for the treatment of chronic pain. A total of 40 randomized controlled trials (2978 participants) were included. Thirty-nine of 40 (97.5%) included mindfulness-based clinical trials allowed the use of CADTs. However, only 6 of these 39 (15.4%) trials provided adequate details of what these CADTs were, and only 4 (10.3%) trials controlled for CADTs. Of great relevance to this review, none of the included trials analyzed the interactions between MBIs and the CADTs to determine whether they have an additive, synergistic, or antagonistic effect on chronic pain. Adverse events were inconsistently reported, and no judgment could be made about safety. Future trials assessing the interactions between MBIs and CADTs, with better harms reporting, are needed to better define the role of MBIs in the management of chronic pain.
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24
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App-Based Pain Management and Opioid Education Program for Patients in Clinic Waiting Rooms. Pain Manag Nurs 2020; 22:164-168. [PMID: 33223470 DOI: 10.1016/j.pmn.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Best approaches to delivering patient education related to pain management and opioid safety are understudied. AIMS This study assessed the feasibility, acceptability, and preliminary patient-reported impact of an app-based patient pain education program. DESIGN Pilot study with data collection occurring on 43 weekdays between August 2019-February 2020. SETTING Waiting rooms at the pain clinic and a primary care medical home within two military treatment facilities. PARTICIPANTS Military health system beneficiaries seeking general care at the primary care medical home or pain-specific care at the pain clinic. METHODS The Joint Pain Education and Project curriculum includes patient-focused videos describing the biopsychosocial aspects of pain and pain management, medication take-back and safe disposal, and multidimensional pain assessments. The app-based videos were available on tablets in the waiting rooms for patients to view and complete surveys on after. RESULTS Overall, 152 patients viewed the videos and completed surveys. Most viewers were interested in receiving other tablet-based health education while in the waiting room (62%). Most viewers found videos to be moderately or very helpful (73%) and were satisfied or very satisfied with the information provided (85%). Participants at the primary care medical home were more likely to find videos helpful compared to participants at the pain clinic (OR = 2.11; 95% CI: 1.07, 4.20; p = .03). CONCLUSION Implementing app-based pain management education is feasible across clinic settings and is well received by patients. Clinics should consider providing pain education across care setting, rather than just pain specialty clinics, to help foster discussions between clinicians and patients regarding pain management and opioid safety.
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25
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Matis J, Svetlak M, Slezackova A, Svoboda M, Šumec R. Mindfulness-Based Programs for Patients With Cancer via eHealth and Mobile Health: Systematic Review and Synthesis of Quantitative Research. J Med Internet Res 2020; 22:e20709. [PMID: 33196452 PMCID: PMC7704284 DOI: 10.2196/20709] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background eHealth mindfulness-based programs (eMBPs) are on the rise in complex oncology and palliative care. However, we are still at the beginning of answering the questions of how effective eMBPs are and for whom, and what kinds of delivery modes are the most efficient. Objective This systematic review aims to examine the feasibility and efficacy of eMBPs in improving the mental health and well-being of patients with cancer, to describe intervention characteristics and delivery modes of these programs, and to summarize the results of the included studies in terms of moderators, mediators, and predictors of efficacy, adherence, and attrition. Methods In total, 4 databases (PubMed, PsycINFO, Scopus, and Web of Knowledge) were searched using relevant search terms (eg, mindfulness, program, eHealth, neoplasm) and their variations. No restrictions were imposed on language or publication type. The results of the efficacy of eMBPs were synthesized through the summarizing effect estimates method. Results
A total of 29 published papers describing 24 original studies were included in this review. In general, the results indicate that eMBPs have the potential to reduce the levels of stress, anxiety, depression, fatigue, sleep problems, and pain, and improve the levels of mindfulness, posttraumatic growth, and some parameters of general health. The largest median of Cohen d effect sizes were observed in reducing anxiety and depression (within-subject: median −0.38, IQR −0.62 to −0.27; between-group:
median −0.42, IQR −0.58 to −0.22) and facilitating posttraumatic growth (within-subject: median 0.42, IQR 0.35 to 0.48;
between-group: median 0.32, IQR 0.22 to 0.39). The efficacy of eMBP may be comparable with that of parallel, face-to-face
MBPs in some cases. All studies that evaluated the feasibility of eMBPs reported that they are feasible for patients with cancer.
Potential moderators, mediators, and predictors of the efficacy, attrition, and adherence of eMBPs are discussed.
Conclusions Although the effects of the reviewed studies were highly heterogeneous, the review provides evidence that eMBPs are an appropriate way for mindfulness practice to be delivered to patients with cancer. Thus far, existing eMBPs have mostly attempted to convert proven face-to-face mindfulness programs to the eHealth mode. They have not yet fully exploited the potential of eHealth technology.
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Affiliation(s)
- Juraj Matis
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic
| | - Miroslav Svetlak
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Slezackova
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Svoboda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Rastislav Šumec
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
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26
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Alenazi AM, Alshehri MM, Alothman S, Alqahtani BA, Rucker J, Sharma NK, Bindawas SM, Kluding PM. The Association of Diabetes With Knee Pain Locations, Pain While Walking, and Walking Speed: Data From the Osteoarthritis Initiative. Phys Ther 2020; 100:1977-1986. [PMID: 32750122 PMCID: PMC7596886 DOI: 10.1093/ptj/pzaa144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) and diabetes mellitus (DM) often coexist and can result in negative outcomes. DM can affect pain and walking speed in people with knee OA; however, the impact of DM on OA is understudied. The purpose of this study was to investigate the association between diabetes and knee pain locations, pain severity while walking, and walking speed in people with knee OA. METHODS A cross-sectional analysis was used. Data from 1790 individuals from the Osteoarthritis Initiative (mean [SD] age = 69 [8.7] years) with knee pain were included and grouped into knee OA and diabetes (n = 236) or knee OA only (n = 1554). Knee pain locations were categorized as no pain, localized pain, regional pain, or diffuse pain. Knee pain during a 20-m walk test was categorized as no pain, mild, moderate, or severe knee pain. Walking speed was measured using the 20-m walk test. Multinomial and linear regression analyses were performed. RESULTS Diabetes was associated with regional knee pain (odds ratio [OR] = 1.77; 95% CI = 1.01-3.11). Diabetes was associated only with moderate (OR = 1.78; 95% CI = 1.02-3.10) or severe (OR = 2.52; 95% CI = 1.01-6.28) pain while walking. Diabetes was associated with decreased walking speed (B = -0.064; 95% CI = -0.09 to -0.03). CONCLUSIONS Diabetes was associated with regional knee pain but not with localized or diffuse knee pain and was associated with moderate to severe knee pain while walking and slower walking speed in people with knee OA. IMPACT Clinicians can use a knee pain map for examining knee pain locations for people with diabetes and knee OA. Knee pain during walking and walking speed should be screened for people with knee OA and diabetes because of the influence of diabetes on these parameters in this population. LAY SUMMARY Diabetes might be associated with specific knee pain locations, pain during activities such as walking, and reduced walking speed in people with knee OA.
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Affiliation(s)
| | | | - Shaima Alothman
- Lifestyle and Health Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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27
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Ong AD, Thoemmes F, Ratner K, Ghezzi-Kopel K, Reid MC. Positive affect and chronic pain: a preregistered systematic review and meta-analysis. Pain 2020; 161:1140-1149. [PMID: 32049895 PMCID: PMC7230030 DOI: 10.1097/j.pain.0000000000001828] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Chronic noncancer pain (CNCP) is a significant health burden among adults. Standard behavioral therapies typically focus on targeting negative affect (NA) and yield only modest treatment effects. The aims of this study were to systematically review and investigate the association between positive affect (PA) and pain severity among adults with CNCP. Databases that were searched included MEDLINE (PubMed), PsycINFO, CINAHL, ProQuest Dissertations and Theses, OLASTER, Open Grey, and PsyArXiv (inception to July 23, 2019). We analyzed studies that: (1) used observational, experimental, or intervention study designs; (2) enrolled individuals with CNCP (pain ≥ 12 weeks); and (3) reported full quantitative results on outcomes. Two researchers independently screened articles, extracted data, and assessed the risk of bias. The main meta-analysis was followed by subgroup analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (Q-statistic; I) and publication bias (p-curve and p-uniform*) were performed. We meta-analyzed 29 studies with 3521 participants. Results demonstrated that PA inversely impacts pain severity in people with CNCP (r = -0.23). Subgroup analyses showed a significant effect for gender and marginally significant effects for age in studies that adjusted for NA. On average, effect sizes for observational studies were larger in studies with a higher proportion of female respondents and in studies that did not adjust for NA. Finally, larger effect sizes were found in intervention studies with older compared with younger samples.
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Affiliation(s)
- Anthony D Ong
- Department of Human Development, Cornell University, Ithaca, NY
- Department of Medicine, Weill Cornell Medical College, New York City, NY, United States
| | - Felix Thoemmes
- Department of Human Development, Cornell University, Ithaca, NY
| | - Kaylin Ratner
- Department of Human Development, Cornell University, Ithaca, NY
| | | | - M Carrington Reid
- Department of Medicine, Weill Cornell Medical College, New York City, NY, United States
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28
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Sharpe L, Jones E, Ashton‐James CE, Nicholas MK, Refshauge K. Necessary components of psychological treatment in pain management programs: A Delphi study. Eur J Pain 2020; 24:1160-1168. [DOI: 10.1002/ejp.1561] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/02/2020] [Accepted: 03/07/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Louise Sharpe
- The School of Psychology University of Sydney Sydney NSW Australia
| | - Emma Jones
- The School of Psychology University of Sydney Sydney NSW Australia
| | | | - Michael K. Nicholas
- Pain Management Research Institute The University of Sydney Sydney NSW Australia
| | - Kathryn Refshauge
- Faculty of Health Sciences The University of Sydney Sydney NSW Australia
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29
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Glynn BA, Khoo EL, MacLeay HML, Duong A, Cantave R, Poulin PA. Exploring Cancer Patients' Experiences of an Online Mindfulness-Based Program: A Qualitative Investigation. Mindfulness (N Y) 2020; 11:1666-1677. [PMID: 32670431 PMCID: PMC7346987 DOI: 10.1007/s12671-020-01380-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective Chronic neuropathic pain (CNP) is a common condition cancer survivors experience. Mindfulness training may be one approach to address the psychosocial factors associated with CNP. The purpose of this study was to understand patients’ experiences in an 8-week online mindfulness-based program (MBP), including techniques and skills learned and applied, barriers to practice, and research experiences. Methods Nineteen participants who were part of a randomized controlled trial consented to participate in a telephone interview or submit written responses via email post-course. Interviews were transcribed and analyzed using the principles of Applied Thematic Analysis (ATA). Results Predominant themes identified in participant interviews included (1) common humanity, (2) convenience, (3) teacher resonance, (4) perceived relaxation and calm, (5) pain and stress management, (6) half-day session, and (7) mindful breathing. Participants also identified helpful strategies learned and implemented from the course, as well as barriers to practice, and key components of their experiences in a randomized controlled trial, including a sense of disconnection post-course and needing continued ongoing sessions, and the importance of the facilitators’ skills in creating a comfortable and supportive space. Conclusions An online group-based MBP may offer a more accessible resource and form of psychosocial intervention and support for cancer survivors living with CNP. Furthermore, the need and consideration for implementing ongoing group maintenance sessions to minimize participants’ feelings of disconnect and abandonment post-course and post-study are warranted in future MBP development.
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Affiliation(s)
- Brittany A Glynn
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Eve-Ling Khoo
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Hayley M L MacLeay
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - An Duong
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Rosemee Cantave
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Patricia A Poulin
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
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Chavez JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS, Dailey AT, Mahan MA, Hood RS, Lawrence BD, Spiker WR, Spina NT, Bisson EF. The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Outcomes in Lumbar Spine Degenerative Disease: 3-Month and 12-Month Results of a Pilot Study. World Neurosurg 2020; 139:e230-e236. [PMID: 32278820 DOI: 10.1016/j.wneu.2020.03.186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND We previously reported inpatient and 30-day postoperative patient-reported outcomes (PROs) of a controlled, noncrossover pilot study using preoperative mindfulness-based stress reduction (MBSR) training for lumbar spine surgery. Our goal here was to assess 3-month and 12-month postoperative PROs of preoperative MBSR in lumbar spine surgery for degenerative disease. METHODS Intervention group participants were prospectively enrolled in a preoperative online MBSR course. A comparison standard care only group was one-to-one matched retrospectively by age, sex, surgery type, and prescription opioid use. Three-month and 12-month postoperative PROs for pain, disability, quality of life, and opioid use were compared within and between groups. Regression models were used to assess whether MBSR use predicted outcomes. RESULTS Twenty-four participants were included in each group. At 3 months, follow-up was 87.5% and 95.8% in the comparison and intervention groups, respectively. In the intervention group, mean Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) was significantly higher, whereas mean Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) and Oswestry Disability Index were significantly lower. The change from baseline in mean PROMIS-PF and PROMIS-PI was significantly greater than in the comparison group. At 12 months, follow-up was 58.3% and 83.3% in the comparison and intervention groups, respectively. In the intervention group, mean PROMIS-PI was significantly lower and change in mean PROMIS-PI from baseline was significantly greater. MBSR use was a significant predictor of change in PROMIS-PF at 3 months and in PROMIS-PI at 12 months. No adverse events were reported. CONCLUSIONS Three-month and 12-month results suggest that preoperative MBSR may have pain control benefits in lumbar spine surgery.
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Affiliation(s)
- Juneyoung L Chavez
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lisa H Gren
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Darrel S Brodke
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Robert S Hood
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Brandon D Lawrence
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - William R Spiker
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Nicholas T Spina
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Gardiner P, D'Amico S, Luo M, Haas N. An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial. JMIR Mhealth Uhealth 2020; 8:e14768. [PMID: 32224487 PMCID: PMC7154936 DOI: 10.2196/14768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023] Open
Abstract
Background Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use. Objective The primary goal of this study was to evaluate the feasibility of OWLCP in reducing pain impact and pain-related outcomes. Methods We conducted a pre-post clinical study (2 cohorts) to assess the feasibility of OWLCP usage among low-income patients with chronic pain. Outcome data, collected at baseline and 9 weeks, included Patient-Reported Outcomes Measurement Information System (PROMIS-29), pain self-efficacy, and pain medication use. In the statistical analysis, we used descriptive statistics, logistic regression, linear regression, and qualitative methods. Results Among the enrolled 43 participants, the average age was 50 years, (39/43) 91% were female, (16/43) 37% were black, and (7/43) 16% were Hispanic. From baseline to follow-up, the PROMIS measures showed a reduction in depression (P=.02), pain interference (P=.003), and average pain impact score (P=.007). Pain self-efficacy increased ((P<.001), whereas opioid use had a 13% reduction (P=.03). Conclusions The eHealth chronic pain management platform, OWLCP, is a potential tool to reduce the impact of chronic pain for low-income racially diverse populations.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States
| | - Salvatore D'Amico
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | - Man Luo
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | - Niina Haas
- BrightOutcome, Buffalo Grove, IL, United States
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Parks AC, Williams AL, Kackloudis GM, Stafford JL, Boucher EM, Honomichl RD. The Effects of a Digital Well-Being Intervention on Patients With Chronic Conditions: Observational Study. J Med Internet Res 2020; 22:e16211. [PMID: 31922491 PMCID: PMC6996718 DOI: 10.2196/16211] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/01/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic conditions account for 75% of health care costs, and the impact of chronic illness is expected to grow over time. Although subjective well-being predicts better health outcomes, people with chronic conditions tend to report lower well-being. Improving well-being might mitigate costs associated with chronic illness; however, existing interventions can be difficult to access and draw from a single theoretical approach. Happify, a digital well-being intervention program drawing from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and nondistressed users. OBJECTIVE This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition. METHODS Data were obtained from Happify users, a publicly available digital well-being program accessible via website or mobile phone app. Users work on tracks addressing a specific issue (eg, conquering negative thoughts) composed of games and activities based on positive psychology, cognitive behavioral therapy, and mindfulness principles. The sample included 821 users receiving at least 6 weeks' exposure to Happify (ranging from 42 to 179 days) who met other inclusion criteria. As part of a baseline questionnaire, respondents reported demographic information (age and gender) and whether they had any of the prespecified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (450 reported a chronic condition, whereas 371 did not). Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed effects linear regression model was fit for subjective well-being, controlling for demographics and platform usage. RESULTS At baseline, users with a chronic condition had significantly lower subjective well-being (mean 38.34, SD 17.40) than users without a chronic condition (mean 43.65, SD 19.13). However, change trajectories for users with or without a chronic condition were not significantly different; both groups experienced equivalent improvements in well-being. We also found an effect for time from baseline (b=0.071; SE=0.010; P<.01) and number of activities completed (b=0.03; SE=0.009; P<.01), and a 2-way interaction between number of activities completed and time from baseline (b=0.0002; SE=0.00006; P<.01), such that completing more activities and doing so over increasingly longer periods produced improved well-being scores. CONCLUSIONS Data from this study support the conclusion that users with a chronic condition experienced significant improvement over time. Despite reporting lower subjective well-being on the whole, their change trajectory while using Happify was equivalent to those without a chronic condition. Consistent with past research, users who completed more activities over a longer period showed the most improvement. In short, the presence of a chronic condition did not prevent users from showing improved well-being when using Happify.
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Ehde DM, Alschuler KN, Day MA, Ciol MA, Kaylor ML, Altman JK, Jensen MP. Mindfulness-based cognitive therapy and cognitive behavioral therapy for chronic pain in multiple sclerosis: a randomized controlled trial protocol. Trials 2019; 20:774. [PMID: 31882017 PMCID: PMC6935157 DOI: 10.1186/s13063-019-3761-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic pain is one of the most prevalent and disabling symptoms associated with multiple sclerosis (MS). Individuals with MS are interested in nonpharmacologic pain management approaches. Cognitive-behavioral therapy (CBT) is efficacious in improving MS-related pain outcomes. Mindfulness-based cognitive therapy (MBCT) is a promising, alternative approach. Little is known about moderators of these treatments' outcomes, however. This article describes the study protocol for the first randomized controlled trial comparing MBCT, CBT, and usual care and examining treatment effect moderators in individuals with chronic pain and MS. METHODS We will conduct a single-center, randomized, single blind, parallel-group trial comparing MBCT, CBT, and usual care in adults with MS and chronic pain. Both interventions will be delivered via eight group sessions using videoconferencing technology. Primary (average pain intensity) and secondary outcomes (including pain interference, depressive symptoms, fatigue, and sleep) will be assessed pre-treatment, mid-treatment, post-treatment, and at 6-month follow up. Potential treatment moderators will be assessed pre-treatment. We hypothesize that participants randomly assigned to MBCT or CBT will report significantly greater reductions in average pain intensity than participants assigned to usual care at post-treatment (primary study endpoint) and 6-month follow up. We also hypothesize that mindfulness, pain catastrophizing, and behavioral activation pre-treatment will moderate response to both active treatments, but not response to usual care. DISCUSSION Findings will provide important new information about the efficacy and moderators of two nonpharmacologic pain management approaches delivered using technology to overcome common barriers to treatment access. The knowledge gained may lead to better patient-treatment matching and, ultimately, better pain treatment outcomes in MS. TRIAL REGISTRATION ClinicalTrials.gov, NCT03782246. Registered on 20 December 2018.
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Affiliation(s)
- Dawn M. Ehde
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Kevin N. Alschuler
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
- Department of Neurology, School of Medicine, University of Washington, UW Multiple Sclerosis Center, 1536 N 115th St, McMurray Building Suite 130, Seattle, WA 98133 USA
| | - Melissa A. Day
- School of Psychology, University of Queensland, 330 McElwain Building, Brisbane, Queensland 4072 Australia
| | - Marcia A. Ciol
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Makena L. Kaylor
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Jennifer K. Altman
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
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Lippmann M, Laudel H, Heinzle M, Narciss S. Relating Instructional Design Components to the Effectiveness of Internet-Based Mindfulness Interventions: A Critical Interpretive Synthesis. J Med Internet Res 2019; 21:e12497. [PMID: 31774413 PMCID: PMC6906627 DOI: 10.2196/12497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 08/17/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Internet-based mindfulness interventions are a promising approach to address challenges in the dissemination and implementation of mindfulness interventions, but it is unclear how the instructional design components of such interventions are associated with intervention effectiveness. OBJECTIVE The objective of this study was to identify the instructional design components of the internet-based mindfulness interventions and provide a framework for the classification of those components relative to the intervention effectiveness. METHODS The critical interpretive synthesis method was applied. In phase 1, a strategic literature review was conducted to generate hypotheses for the relationship between the effectiveness of internet-based mindfulness interventions and the instructional design components of those interventions. In phase 2, the literature review was extended to systematically explore and revise the hypotheses from phase 1. RESULTS A total of 18 studies were identified in phase 1; 14 additional studies were identified in phase 2. Of the 32 internet-based mindfulness interventions, 18 were classified as more effective, 11 as less effective, and only 3 as ineffective. The effectiveness of the interventions increased with the level of support provided by the instructional design components. The main difference between effective and ineffective interventions was the presence of just-in-time information in the form of reminders. More effective interventions included more supportive information (scores: 1.91 in phases 1 and 2) than less effective interventions (scores: 1.00 in phase 1 and 1.80 in phase 2), more part-task practice (scores: 1.18 in phase 1 and 1.60 in phase 2) than less effective interventions (scores: 0.33 in phase 1 and 1.40 in phase 2), and provided more just-in-time information (scores: 1.35 in phase 1 and 1.67 in phase 2) than less effective interventions (scores: 0.83 in phase 1 and 1.60 in phase 2). The average duration of more effective, less effective, and ineffective interventions differed for the studies of phase 1, with more effective interventions taking up more time (7.45 weeks) than less effective (4.58 weeks) or ineffective interventions (3 weeks). However, this difference did not extend to the studies of phase 2, with comparable average durations of effective (5.86 weeks), less effective (5.6 weeks), and ineffective (7 weeks) interventions. CONCLUSIONS Our results suggest that to be effective, internet-based mindfulness interventions must contain 4 instructional design components: formal learning tasks, supportive information, part-task practice, and just-in-time information. The effectiveness of the interventions increases with the level of support provided by each of these instructional design components.
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Affiliation(s)
- Marie Lippmann
- Department of Psychology, California State University, Chico, CA, United States
| | - Helena Laudel
- Psychology of Learning and Instruction, Faculty of Psychology - School of Science, Technische Universität Dresden, Dresden, Germany
| | - Marlene Heinzle
- Department of Media, Cognition and Communication, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Narciss
- Psychology of Learning and Instruction, Faculty of Psychology - School of Science, Technische Universität Dresden, Dresden, Germany
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Hamasaki T, Pelletier R, Bourbonnais D, Harris P, Choinière M. Pain-related psychological issues in hand therapy. J Hand Ther 2019; 31:215-226. [PMID: 29449064 DOI: 10.1016/j.jht.2017.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/16/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Literature review. INTRODUCTION Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one's cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients' psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing. PURPOSE OF THE STUDY This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors. METHODS AND RESULTS This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences. DISCUSSION AND CONCLUSION Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients' beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients' pain is thus essential for hand therapists.
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Affiliation(s)
- Tokiko Hamasaki
- Research Center of the CHUM, Montreal, Québec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Hand Center, CHUM, Montreal, Québec, Canada
| | - René Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Daniel Bourbonnais
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
| | - Patrick Harris
- Hand Center, CHUM, Montreal, Québec, Canada; Department of Surgery, Plastic Surgery Service, CHUM, Montreal, Québec, Canada; Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Manon Choinière
- Research Center of the CHUM, Montreal, Québec, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
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Moman RN, Hooten WM. The Major Barrier Facing Patients and Clinicians Who Are Interested in Utilization of Electronic and Mobile Health Technologies. PAIN MEDICINE 2019; 21:e243-e246. [DOI: 10.1093/pm/pnz273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine
| | - W Michael Hooten
- Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Moman RN, Dvorkin J, Pollard EM, Wanderman R, Murad MH, Warner DO, Hooten WM. A Systematic Review and Meta-analysis of Unguided Electronic and Mobile Health Technologies for Chronic Pain—Is It Time to Start Prescribing Electronic Health Applications? PAIN MEDICINE 2019; 20:2238-2255. [DOI: 10.1093/pm/pnz164] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Electronic (eHealth) and mobile (mHealth) technologies may be a useful adjunct to clinicians treating patients with chronic pain. The primary aim of this study was to investigate the effects of eHealth and mHealth interventions that do not require clinician contact or feedback on pain-related outcomes recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) guidelines in adults with chronic pain.
Methods
We searched four databases and included English language randomized controlled trials of ambulatory adults with chronic pain from January, 1 2000, to January 31, 2018, with interventions that are independent of clinician contact or feedback. In the meta-analysis, outcomes were assessed at short- (three months or less), intermediate- (four to six months), and long-term (seven or more months) follow-up.
Results
Seventeen randomized controlled trials (N = 2,496) were included in the meta-analysis. Both eHealth and mHealth interventions had a significant effect on pain intensity at short- and intermediate-term follow-up. Similarly, a significant but small effect was observed for depression at short- and intermediate-term follow-up and self-efficacy at short-term follow-up. Finally, a significant effect was observed for pain catastrophizing at short-term follow-up.
Conclusions
eHealth and mHealth interventions had significant effects on multiple short- and intermediate-term outcome measures recommended in the IMMPACT guidelines. Given widespread availability and low cost to patients, clinicians treating patients with chronic pain could consider using eHealth and mHealth interventions as part of a multidisciplinary pain treatment strategy.
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Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jodie Dvorkin
- Institute for Clinical Systems Improvement, Minneapolis, Minnesota
| | - E Morgan Pollard
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robalee Wanderman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Division of Preventive Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - W Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Gregory VL. Cognitive-behavioral group therapy and buprenorphine: Balancing methodological rigor and community partner ethical concerns in efficacy-effectiveness trials. ETHICS & BEHAVIOR 2019. [DOI: 10.1080/10508422.2019.1604233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Day MA, Ward LC, Ehde DM, Thorn BE, Burns J, Barnier A, Mattingley JB, Jensen MP. A Pilot Randomized Controlled Trial Comparing Mindfulness Meditation, Cognitive Therapy, and Mindfulness-Based Cognitive Therapy for Chronic Low Back Pain. PAIN MEDICINE 2019; 20:2134-2148. [DOI: 10.1093/pm/pny273] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AbstractObjectiveThis pilot trial compared the feasibility, tolerability, acceptability, and effects of group-delivered mindfulness meditation (MM), cognitive therapy (CT), and mindfulness-based cognitive therapy (MBCT) for chronic low back pain (CLBP).SettingUniversity of Queensland Psychology Clinic.SubjectsParticipants were N = 69 (intent-to-treat [ITT] sample) adults with CLBP.DesignA pilot, assessor-blinded randomized controlled trial.MethodsParticipants were randomized to treatments. The primary outcome was pain interference; secondary outcomes were pain intensity, physical function, depression, and opioid medication use. The primary study end point was post-treatment; maintenance of gains was evaluated at three- and six-month follow-up.ResultsRatings of acceptability, and ratios of dropout and attendance showed that MBCT was acceptable, feasible, and well tolerated, with similar results found across conditions. For the ITT sample, large improvements in post-treatment scores for pain interference, pain intensity, physical function, and depression were found (P < 0.001), with no significant between-group differences. Analysis of the follow-up data (N = 43), however, revealed that MBCT participants improved significantly more than MM participants on pain interference, physical function, and depression. The CT group improved more than MM in physical function. The MBCT and CT groups did not differ significantly on any measures.ConclusionsThis is the first study to examine MBCT for CLBP management. The findings show that MBCT is a feasible, tolerable, acceptable, and potentially efficacious treatment option for CLBP. Further, MBCT, and possibly CT, could have sustained benefits that exceed MM on some important CLBP outcomes. A future definitive randomized controlled trial is needed to evaluate these treatments and their differences.
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Affiliation(s)
- Melissa A Day
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - L Charles Ward
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Beverly E Thorn
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
| | - John Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Amanda Barnier
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, New South Wales, Australia
| | - Jason B Mattingley
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Yi JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS, Dailey AT, Mahan MA, Hood RS, Lawrence BD, Spiker WR, Spina NT, Bisson EF. The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: A Pilot Study. World Neurosurg 2019; 121:e786-e791. [DOI: 10.1016/j.wneu.2018.09.223] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/01/2022]
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SMOOTH: Self-Management of Open Online Trials in Health analysis found improvements were needed for reporting methods of internet-based trials. J Clin Epidemiol 2018; 105:27-39. [PMID: 30171901 DOI: 10.1016/j.jclinepi.2018.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 08/01/2018] [Accepted: 08/24/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The growth of trials conducted over the internet has increased, but with little practical guidance for their conduct, and it is sometimes challenging for researchers to adapt the conventions used in face-to-face trials and maintain the validity of the work. The aim of the study is to systematically explore existing self-recruited online randomized trials of self-management interventions and analyze the trials to assess their strengths and weaknesses, the quality of reporting, and the involvement of lay persons as collaborators in the research process. STUDY DESIGN AND SETTINGS The Online Randomized Controlled Trials of Health Information Database was used as the sampling frame to identify a subset of self-recruited online trials of self-management interventions. The authors cataloged what these online trials were assessing, appraised study quality, extracted information on how trials were run, and assessed the potential for bias. We searched out how public and patient participation was integrated into online trial design and how this was reported. We recorded patterns of use for registration, reporting, settings, informed consent, public involvement, supplementary materials, and dissemination planning. RESULTS The sample included 41 online trials published from 2002 to 2015. The barriers to replicability and risk of bias in online trials included inadequate reporting of blinding in 28/41 (68%) studies; high attrition rates with incomplete or unreported data in 30/41 (73%) of trials; and 26/41 (63%) of studies were at high risk for selection bias as trial registrations were unreported. The methods for (23/41, 56%) trials contained insufficient information to replicate the trial, 19/41 did not report piloting the intervention. Only 2/41 studies were cross-platform compatible. Public involvement was most common for advisory roles (n = 9, 22%), and in the design, usability testing, and piloting of user materials (n = 9, 22%). CONCLUSION This study catalogs the state of online trials of self-management in the early 21st century and provides insights for online trials development as early as the protocol planning stage. Reporting of trials was generally poor and, in addition to recommending that authors report their trials in accordance with CONSORT guidelines, we make recommendations for researchers writing protocols, reporting on and evaluating online trials. The research highlights considerable room for improvement in trial registration, reporting of methods, data management plans, and public and patient involvement in self-recruited online trials of self-management interventions.
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Russell L, Ugalde A, Milne D, Austin D, Livingston PM. Digital Characteristics and Dissemination Indicators to Optimize Delivery of Internet-Supported Mindfulness-Based Interventions for People With a Chronic Condition: Systematic Review. JMIR Ment Health 2018; 5:e53. [PMID: 30131317 PMCID: PMC6123540 DOI: 10.2196/mental.9645] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/07/2018] [Accepted: 06/21/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Internet-supported mindfulness-based interventions (MBIs) are increasingly being used to support people with a chronic condition. Characteristics of MBIs vary greatly in their mode of delivery, communication patterns, level of facilitator involvement, intervention period, and resource intensity, making it difficult to compare how individual digital features may optimize intervention adherence and outcomes. OBJECTIVE The aims of this review were to (1) provide a description of digital characteristics of internet-supported MBIs and examine how these relate to evidence for efficacy and adherence to the intervention and (2) gain insights into the type of information available to inform translation of internet-supported MBIs to applied settings. METHODS MEDLINE Complete, PsycINFO, and CINAHL databases were searched for studies assessing an MBI delivered or accessed via the internet and engaging participants in daily mindfulness-based activities such as mindfulness meditations and informal mindfulness practices. Only studies using a comparison group of alternative interventions (active compactor), usual care, or wait-list were included. Given the broad definition of chronic conditions, specific conditions were not included in the original search to maximize results. The search resulted in 958 articles, from which 11 articles describing 10 interventions met the inclusion criteria. RESULTS Internet-supported MBIs were more effective than usual care or wait-list groups, and self-guided interventions were as effective as facilitator-guided interventions. Findings were informed mainly by female participants. Adherence to interventions was inconsistently defined and prevented robust comparison between studies. Reporting of factors associated with intervention dissemination, such as population representativeness, program adoption and maintenance, and costs, was rare. CONCLUSIONS More comprehensive descriptions of digital characteristics need to be reported to further our understanding of features that may influence engagement and behavior change and to improve the reproducibility of MBIs. Gender differences in determinants and patterns of health behavior should be taken into account at the intervention design stage to accommodate male and female preferences. Future research could compare MBIs with established evidence-based therapies to identify the population groups that would benefit most from internet-supported programs. TRIAL REGISTRATION PROSPERO CRD42017078665; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=78665 (Archived by WebCite at http://www.webcitation.org/71ountJpu).
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Affiliation(s)
- Lahiru Russell
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Donna Milne
- Melanoma and Skin Services, Peter MacCallum Cancer Center, Melbourne, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Center, Melbourne, Australia
| | - David Austin
- School of Psychology, Deakin University, Geelong, Australia
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Abstract
PURPOSE OF REVIEW Psychological factors are associated with chronic pain. Mindfulness meditation may ameliorate symptoms. The objective was to evaluate the effects of mindfulness meditation in chronic pain. RECENT FINDINGS A systematic search of four databases identified 534 citations; 13 Randomised controlled trials satisfied the inclusion criteria. Mindfulness meditation significantly reduced depression [Standardised mean difference (SMD) -0.28; 95% confidence interval (CI) -0.53, -0.03; P = 0.03; I = 0%]. For affective pain (SMD -0.13; 95% CI -0.42, 0.16; I = 0%), sensory pain (SMD -0.02; 95% CI -0.31, 0.27; I = 0%) and anxiety (SMD -0.16; 95% CI -0.47, 0.15; I = 0%) there was a trend towards benefit with intervention. Quality of life items on mental health (SMD 0.65; 95% CI -0.27, 1.58; I = 69%), physical health (SMD 0.08; 95% CI -0.40, 0.56; I = 32%) and overall score (SMD 0.86, 95% CI -0.06, 1.78; I = 88%) improved with mindfulness meditation. SUMMARY Mindfulness meditation has most prominent effect on psychological aspects on living with chronic pain, improving associated depression and quality of life.
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The effectiveness of various computer-based interventions for patients with chronic pain or functional somatic syndromes: A systematic review and meta-analysis. PLoS One 2018; 13:e0196467. [PMID: 29768436 PMCID: PMC5955495 DOI: 10.1371/journal.pone.0196467] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/15/2018] [Indexed: 12/28/2022] Open
Abstract
Computer-based interventions target improvement of physical and emotional functioning in patients with chronic pain and functional somatic syndromes. However, it is unclear to what extent which interventions work and for whom. This systematic review and meta-analysis (registered at PROSPERO, 2016: CRD42016050839) assesses efficacy relative to passive and active control conditions, and explores patient and intervention factors. Controlled studies were identified from MEDLINE, EMBASE, PsychInfo, Web of Science, and Cochrane Library. Pooled standardized mean differences by comparison type, and somatic symptom, health-related quality of life, functional interference, catastrophizing, and depression outcomes were calculated at post-treatment and at 6 or more months follow-up. Risk of bias was assessed. Sub-group analyses were performed by patient and intervention characteristics when heterogeneous outcomes were observed. Maximally, 30 out of 46 eligible studies and 3,387 participants were included per meta-analysis. Mostly, internet-based cognitive behavioral therapies were identified. Significantly higher patient reported outcomes were found in comparisons with passive control groups (standardized mean differences ranged between -.41 and -.18), but not in comparisons with active control groups (SMD = -.26 - -.14). For some outcomes, significant heterogeneity related to patient and intervention characteristics. To conclude, there is a minority of good quality evidence for small positive average effects of computer-based (cognitive) behavior change interventions, similar to traditional modes. These effects may be sustainable. Indications were found as of which interventions work better or more consistently across outcomes for which patients. Future process analyses are recommended in the aim of better understanding individual chances of clinically relevant outcomes.
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O'Connor M, Munnelly A, Whelan R, McHugh L. The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Behav Ther 2018; 49:459-475. [PMID: 29704973 DOI: 10.1016/j.beth.2017.07.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/12/2017] [Accepted: 07/21/2017] [Indexed: 01/12/2023]
Abstract
eHealth is an innovative method of delivering therapeutic content with the potential to improve access to third-wave behaviural and cognitive therapies. This systematic review and meta-analysis aimed to determine the efficacy and acceptability of third-wave eHealth treatments in improving mental health outcomes. A comprehensive search of electronic bibliographic databases including PubMed, PsycINFO, Web of Science, and CENTRAL was conducted to identify randomized controlled trials of third-wave treatments in which eHealth was the main component. Twenty-one studies were included in the review. Meta-analyses revealed that third-wave eHealth significantly outperformed inactive control conditions in improving anxiety, depression, and quality-of-life outcomes and active control conditions in alleviating anxiety and depression with small to medium effect sizes. No statistically significant differences were found relative to comparison interventions. Findings from a narrative synthesis of participant evaluation outcomes and meta-analysis of participant attrition rates provided preliminary support for the acceptability of third-wave eHealth. Third-wave eHealth treatments are efficacious in improving mental health outcomes including anxiety, depression, and quality of life, but not more so than comparison interventions. Preliminary evidence from indices of participant evaluation and attrition rates supports the acceptability of these treatments.
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Affiliation(s)
| | | | - Robert Whelan
- Trinity Institute of Neurosciences, Trinity College Dublin, The University of Dublin
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Mathersul DC, Mahoney LA, Bayley PJ. Tele-yoga for Chronic Pain: Current Status and Future Directions. Glob Adv Health Med 2018; 7:2164956118766011. [PMID: 29637012 PMCID: PMC5888810 DOI: 10.1177/2164956118766011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/13/2018] [Accepted: 02/19/2018] [Indexed: 01/18/2023] Open
Abstract
Pain is a pervasive, debilitating disorder that is resistant to long-term pharmacological interventions. Although psychological therapies such as cognitive behavior therapy demonstrate moderate efficacy, many individuals continue to have ongoing difficulties following treatment. There is a current trend to establish complementary and integrative health interventions for chronic pain, for which yoga has been found to have exciting potential. Nevertheless, an important consideration within the field is accessibility to adequate care. Telehealth can be used to provide real-time interactive video conferencing leading to increased access to health care for individuals located remotely or who otherwise have difficulty accessing services, perhaps through issues of mobility or proximity of adequate services. This article assesses the current status and feasibility of implementing tele-yoga for chronic pain. Methodological limitations and recommendations for future research are discussed.
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Affiliation(s)
- Danielle C Mathersul
- 1War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Louise A Mahoney
- 1War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Peter J Bayley
- 1War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Westenberg RF, Zale EL, Heinhuis TJ, Özkan S, Nazzal A, Lee SG, Chen NC, Vranceanu AM. Does a Brief Mindfulness Exercise Improve Outcomes in Upper Extremity Patients? A Randomized Controlled Trial. Clin Orthop Relat Res 2018; 476:790-798. [PMID: 29480886 PMCID: PMC6260083 DOI: 10.1007/s11999.0000000000000086] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mindfulness-based interventions are useful in reducing psychologic distress and pain intensity in patients with chronic pain. However, most mindfulness-based interventions are resource-intensive, lengthy, and not feasible for busy orthopaedic surgical practices. QUESTIONS/PURPOSES The purpose of this study was to determine if a 60-second personalized mindfulness-based video exercise is (1) associated with improved pain intensity, emotional distress, and state anxiety compared with an attention placebo control (a time-matched educational pamphlet about pain and stress); and (2) feasible and acceptable for patients with upper extremity injury in an orthopaedic practice. METHODS This was a single-center, single-blind randomized controlled trial of the mindfulness-based video exercise (60 seconds duration, free online) versus an attention placebo control (an educational pamphlet about pain and stress presented to patients to read over 60 seconds). One hundred forty-nine patients presenting for a new or followup appointment at the office of one of two orthopaedic hand and upper extremity outpatient surgical practices at an urban academic hospital were invited to participate between September 2016 and December 2016. Of 149 patients screened, 125 patients were randomized and completed a demographic questionnaire, the Numeric Rating Scale to assess pain intensity, the State Anxiety subscale of the State Trait Anxiety Inventory to assess state anxiety, and Emotion Thermometers to assess anxiety, anger, and depression before and after the interventions. Postintervention, patients also completed the Client Satisfaction Questionnaire Scale-3 to assess the acceptability. A mean score of 21 or higher is considered acceptable. Feasibility was determined based on number of patients approached who refused participation. The intervention was defined as feasible if refusal rate was lower than 25%. Analysis of covariance was used to test comparative improved pain intensity on the NRS, psychologic distress on the Emotion Thermometers, and state anxiety on the State Anxiety Subscale of the State Trait Anxiety Index after controlling for respective baseline scores. A 1-point minimal clinically important difference (MCID) was used on the NRS for pain intensity. RESULTS Adjusted for the baseline means, compared with patients who received the attention placebo control, patients who participated in the mindfulness-based video exercise demonstrated improved pain intensity (mindfulness-based video exercise: 3.03 ± 0.12; control: 3.49 ± 0.12; mean difference: 0.46 [0.12-0.80]; p = 0.008); state anxiety (mindfulness-based video exercise: 32.35 ± 0.59; control: 35.29 ± 0.59; mean difference: 2.94 [1.29-4.59]; p = 0.001); anxiety symptoms (mindfulness-based video exercise: 1.49 ± 0.19; control: 2.10 ± 0.19; mean difference: 0.61 [0.08-1.14]; p = 0.024); depression (mindfulness-based video exercise: 1.03 ± 0.10; control: 1.47 ± 0.11; mean difference: 0.44 [0.15-0.73]; p = 0.004); and anger (mindfulness-based video exercise: 0.76 ± 0.12; control: 1.36 ± 0.12; mean difference: 0.60 [0.26-0.94]; p = 0.001). However, the observed differences in pain intensity were below 1 point on the NRS, which is the MCID established in patients with chronic pain. No MCID is available for the other measures. The mindfulness-based video exercise was feasible based on a dropout rate of 0%, and acceptability reached the medium range with similar scores in both groups (mindfulness-based video exercise: 20.70 ± 5.48; control: 20.52 ± 6.42). CONCLUSIONS A 60-second mindfulness-based video exercise is feasible to implement and acceptable to patients in busy orthopaedic practices. This video exercise is also effective in improving momentary pain, anxiety, depression, and anger in this population, but it is unclear whether these improved pain and distress levels are meaningful to patients who present with low levels of pain and psychologic distress. Future studies should seek to discern whether the improved pain and distress levels we observed are clinically important or whether the intervention delivers larger effects in subgroups of patients experiencing greater pain intensity and if the improved pain and distress levels are durable. Such studies might also assess cost-effectiveness, because this mindfulness-based tool takes little time and few resources to use, and the effects and durability of multiple sessions of a mindfulness-based video exercise. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Ritsaart F Westenberg
- R. F. Westenberg, S. Özkan, A. Nazzal, S.-G. Lee, N. C. Chen, Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA E. L. Zale, T. J. Heinhuis, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA E. L. Zale, Department of Psychology, Syracuse University, Syracuse, NY, USA S. Özkan, Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial. Spinal Cord 2018; 56:750-761. [PMID: 29581519 DOI: 10.1038/s41393-018-0090-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Between-subjects, randomized controlled feasibility study. OBJECTIVES Populations with reduced sensory and motor function are at increased risk of depression, anxiety and pain, and may be less geographically mobile. This study explored the efficacy and feasibility of web-based mindfulness training for people with spinal cord injury (SCI). SETTING UK community sample. METHODS Participants were randomly allocated to an 8-week online mindfulness intervention (N = 36), or to internet-delivered psychoeducation (N = 31). Depression symptom severity was the primary outcome. Secondary outcomes included anxiety, quality of life (QoL), pain perception, pain catastrophizing and mindfulness. Measures were taken before (T1), at completion of, (T2), and 3 months following the intervention (T3). RESULTS At T2, ten participants discontinued mindfulness training, and five discontinued psychoeducation. Dropouts were of significantly older age. Nine participants were lost to follow-up. Mindfulness reduced depression significantly more than psychoeducation at T2 (mean difference = -1.50, 95% CI [-2.43, -0.58]) and T3 (mean difference = -2.34, 95% CI [-3.62, -1.10]). Anxiety, pain unpleasantness and catastrophizing were significantly reduced compared with psychoeducation. Total mindfulness scores, and all facets of mindfulness except observing were significantly higher following mindfulness training. At follow-up, reductions in anxiety and catastrophizing persisted. CONCLUSIONS Internet-delivered mindfulness training offers unique benefits and is viable for people with reduced sensory awareness. Future work should explore the feasibility of combined education and mindfulness training. The use of brief interventions shows promise in maximizing participant retention.
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