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Adachi Y, Hosoi M, Nishihara T, Hirabayashi N, Sawa T, Matsushita T, Tatsushima K, Anno K, Tomioka M, Sudo N. Case Report: Nonverbal approaches in the treatment of a patient with fibromyalgia with anger rooted in adverse childhood experiences. FRONTIERS IN PAIN RESEARCH 2024; 5:1374324. [PMID: 38818235 PMCID: PMC11137261 DOI: 10.3389/fpain.2024.1374324] [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: 01/21/2024] [Accepted: 04/15/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction In psychotherapy, it is important to establish and deepen a therapeutic trusting relationship, but patients who have experienced extreme adversity in childhood tend to have difficulty in building such a relationship. This paper reports a case of fibromyalgia with adverse childhood experiences (ACEs) in which a nonverbal approach was successful in building a trusting relationship. Case and methods The patient is a woman in her late 40s. She had strong anger rooted in ACEs, including neglect by her father, a feeling of unfair parenting by her mother compared to her younger brother, overcontrol of her life by her mother, and sexual abuse by her uncle. She was filled with strong interpersonal distrust and anger, and the experience of an unsuccessful surgery compounded her distrust of medical care. The therapist initially had severe difficulty in verbal interaction with the patient. When conducting "drawing" therapy, she ignored the therapist's comments and completely blacked out the drawing paper. However, the patient-therapist relationship gradually changed, and verbal interaction became possible through the use of nonverbal approaches such as framing her drawing paper and "Towel Baby Holding." Results The therapist was able to understand the patient's emotions through these nonverbal approaches and to communicate with the patient that she understood her feelings. This approach was also successful in the patient's understanding of her own pathology. The patient became able to honestly express her feelings in words, which eventually enabled her to be introduced to mindfulness therapy, leading to a favorable treatment course. Conclusion For patients with ACEs, a nonverbal approach helps build a therapeutic relationship and plays an important role in understanding the patient.
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Affiliation(s)
- Yuri Adachi
- The Health Center of Fukuoka Dental College and Fukuoka Nursing College, Fukuoka College of Health Sciences, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoe Nishihara
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Naoki Hirabayashi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takako Sawa
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Independent Counseling Facility, Kotonoha Child Developmental Counseling Room, Ebetsu, Japan
| | - Tomoko Matsushita
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Keita Tatsushima
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Kozo Anno
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
| | - Mitsunao Tomioka
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Health Support and Counseling Center, Reiwa Health Sciences University, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Prikhodkina M, Melnikov S. Factors that influence medication adherence in women with fibromyalgia: A path analysis. J Clin Nurs 2024. [PMID: 38284436 DOI: 10.1111/jocn.17044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
AIMS To investigate the relationships between depression symptoms, perceived stigma, disease severity, patient-provider communication and medication adherence in fibromyalgia patients. The objectives were to explore how these factors influence treatment adherence and to develop a comprehensive model illustrating their interconnections. BACKGROUND Fibromyalgia is a chronic pain syndrome with fatigue, sleep issues and idiopathic pain. Medication adherence is limited by insufficient symptom relief, side effects and costs. Stigma further complicates fibromyalgia. Disease severity affects patient-provider communication. Associations between depression, stigma, severity, communication and adherence in fibromyalgia are unclear. DESIGN A cross-sectional, correlational study. METHODS The STROBE guidelines for cross-sectional studies were followed. Participants included Hebrew-speaking participants who were members of two Facebook groups: 'Shades of Purple' and 'Fibromyalgia- Get to Know!' Between February and April 2022. They undertook evaluations using The Patient Health Questionnaire-9 to gauge depression symptoms, assessed perceived stigma, utilised The Revised Fibromyalgia Impact Questionnaire to determine disease severity, employed The Patient Reaction Assessment questionnaire for patient-provider communication, and used the 8-item Morisky Medication Adherence Scale (MMAS-8). Associations between the variables were explored using Pearson's correlations and path analyses. RESULTS The study included 141 women with fibromyalgia, aged 22 to 76 years. Most reported having a stable partner (69.5%) and 75.2% had children. The treatment adherence levels were as follows: 53.2% (N = 75)-low, 33.3% (N = 47)-medium and 13.5% (N = 19)-high. Depression positively correlated with stigma. Stigma negatively correlated with patient-provider communication. Patient-provider communication positively correlated with treatment adherence. A significant negative indirect effect of depression on treatment adherence through stigma and patient-provider communication was found. CONCLUSIONS Perceived stigma and patient-provider communication played a mediating role in the relationships between depression and treatment adherence among women with fibromyalgia. RELEVANCE TO CLINICAL PRACTICE Addressing stigma related to fibromyalgia and effective patient-provider communication can positively influence treatment adherence. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Maria Prikhodkina
- Nursing Department, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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McConnell K, Heron N, Hart ND. Explaining a diagnosis of fibromyalgia in primary care: a scoping review. BJGP Open 2023; 7:BJGPO.2023.0033. [PMID: 37468158 PMCID: PMC11176698 DOI: 10.3399/bjgpo.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/22/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Fibromyalgia is a common cause of chronic pain in the UK, with a huge individual and societal impact. Despite this, it remains difficult to diagnose and treat. The explanation of a fibromyalgia diagnosis can lead to difficult therapeutic relationships, with attitudinal issues and negative profiling of patients. This can lead to frustration, and have a harmful impact on health outcomes. AIM To review how an explanation of a fibromyalgia diagnosis is provided in primary care in order to establish a model of best practice when educating patients on their diagnosis. DESIGN & SETTING Scoping review of articles written in English. METHOD MEDLINE, Embase, Web of Science, and grey literature were searched. Articles were extracted, reviewed, and analysed according to the inclusion criteria. RESULTS In total, 29 records met the inclusion criteria. The following six overarching themes were identified: patient education; physician education; importance of the multidisciplinary team; importance of patient-centred care; the value of primary care; and useful resources. The literature illustrated that describing fibromyalgia using analogies to illustrate the pain sensitisation process can help patients understand their diagnosis better. This improves their willingness to accept management plans, particularly engagement with non-pharmacological therapies, which the literature suggested are best delivered within a multidisciplinary team. CONCLUSION Key aspects of fibromyalgia should be explained to patients in order for them to gain a better understanding of their diagnosis. A 'one-size-fits-all' model for explaining the fibromyalgia diagnosis to patients is inappropriate because patients' experiences are individualised. Further research is required on whether different explanations impact patient outcomes.
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Affiliation(s)
- Kerrie McConnell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Neil Heron
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Nigel D Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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4
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Wang XJ, Ebbert JO, Loftus CG, Rosedahl JK, Philpot LM. Comorbid extra-intestinal central sensitization conditions worsen irritable bowel syndrome in primary care patients. Neurogastroenterol Motil 2023; 35:e14546. [PMID: 36807964 DOI: 10.1111/nmo.14546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/25/2022] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is characterized as a central sensitization syndrome (CSS), a group of conditions including fibromyalgia, chronic fatigue, and restless leg syndrome (RLS) among others with frequent comorbidities of anxiety, depression, and chemical sensitivity. The prevalence of comorbid conditions and their impact on IBS symptom severity and quality of life in rural community populations has not been described. METHODS We administered a cross-sectional survey to patients with a documented CSS diagnosis in rural primary care practices to evaluate the relationship between CSS diagnoses, quality of life, symptom severity, and interactions with healthcare providers utilizing validated questionnaires. Subgroup analysis was performed on the IBS cohort. Mayo Clinic IRB approved the study. KEY RESULTS Seven hundred seventy-five individuals out of 5000 completed the survey (15.5% response rate) with 264 (34%) reporting IBS. Only 3% (n = 8) of IBS patients reported IBS alone without comorbid CSS condition. Most respondents reported overlapping migraine (196, 74%), depression (183, 69%), anxiety (171, 64%), and fibromyalgia (139, 52%). IBS patients with more than two comorbid CS condition showed significantly higher symptom severity with linear increase. Quality of life was lower in IBS with comorbid conditions, particularly in patients with IBS and RLS (mean EQ5-D 0.36 vs. 0.8 in IBS only, p < 0.01). Quality of life declined as number of comorbid conditions increased. CONCLUSIONS & INFERENCES Patients with IBS often have multiple CS disorders which increases symptom severity and lowers quality of life. Understanding the impact of multiple CSS diagnoses and treating these as a global condition may improve patient experience.
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Affiliation(s)
- Xiao Jing Wang
- Gastroenterology and Hepatology, Mayo Clinic, Minnesota, Rochester, USA
| | - Jon O Ebbert
- Community Internal Medicine, Mayo Clinic, Minnesota, Rochester, USA
| | - Connor G Loftus
- Gastroenterology and Hepatology, Mayo Clinic, Minnesota, Rochester, USA
| | - Jordan K Rosedahl
- Quantitative Health Sciences, Mayo Clinic, Minnesota, Rochester, USA
| | - Lindsey M Philpot
- Community Internal Medicine, Mayo Clinic, Minnesota, Rochester, USA
- Quantitative Health Sciences, Mayo Clinic, Minnesota, Rochester, USA
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Longstreth GF, Attix C, Kuck J. Torture Survivors and Asylum: Legal, Medical, and Psychological Perspectives. Am J Med 2023; 136:244-251. [PMID: 36370801 DOI: 10.1016/j.amjmed.2022.10.014] [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: 09/30/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
Torture occurs worldwide. Survivors seeking asylum are detained and must complete a complicated legal process to prove a "well-founded fear of persecution" if returned to their home countries. Forensic evaluations guided by the United Nations Istanbul Protocol increase asylum grant rates. Medical evaluation emphasizes skin examination, which can provide strong evidence of torture. Female genital mutilation and cutting, a basis for asylum, is classified according to the World Health Organization. Many resettled refugees and foreign-born immigrants at urban health care facilities have been tortured, but few report it to physicians due to factors affecting both survivors and physicians. Specific torture methods can cause characteristic long-term sequelae. Painful somatic disorders of mind-body interaction and psychological disorders are common. Practices derived from cultural factors and traumatized individuals' feedback enhance management of survivors. Individual and group psychotherapy provide modest proven benefit, but assessment is limited. Physicians and psychotherapists should coordinate care.
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Affiliation(s)
- George F Longstreth
- Survivors of Torture International, San Diego, Calif; Veterans Administration San Diego Healthcare System, San Diego, Calif.
| | | | - Julie Kuck
- Survivors of Torture International, San Diego, Calif
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Metri S, Shesser R, Pourmand A. Recurrent abdominal pain visits to the emergency department: A case report using the Central Sensitization Inventory. Am J Emerg Med 2022; 63:177.e1-177.e4. [PMID: 36150946 DOI: 10.1016/j.ajem.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain conditions are among the most common complaints seen in the emergency department (ED). Exacerbations of these conditions are often approached as one would an acute painful condition, with liberal use of imaging, labs, and analgesics. This patient population is often prescribed short courses of opioids without a definite explanation for their painful episodes and often leave the ED dissatisfied with their experience. We describe a patient with a history of chronic abdominal pain who presented to the ED with an exacerbation of his pain. Upon further review of his previous records, we noted that this patient experienced many similar events, resulting in 46 imaging studies over the past year. At this point, the patient was given the Central Sensitization Inventory, and his score demonstrated severe underlying central sensitization. The patient was counseled about his condition and provided with appropriate follow-up care.
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Affiliation(s)
- Samer Metri
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Robert Shesser
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
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Feng B, Hu X, Lu WW, Wang Y, Ip WY. Cultural Validation of the Chinese Central Sensitization Inventory in Patients with Chronic Pain and its Predictive Ability of Comorbid Central Sensitivity Syndromes. J Pain Res 2022; 15:467-477. [PMID: 35210847 PMCID: PMC8857991 DOI: 10.2147/jpr.s348842] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Central sensitization (CS) is frequently reported in chronic pain, and the central sensitization inventory (CSI) is popularly used to assess CS. However, a validated Chinese CSI is lacking and its predictive ability for the comorbidity of central sensitivity syndromes (CSSs) remains unclear. Hence, this study aimed to generate the Chinese CSI (CSI-C) with cultural adaptation and examine its psychometric properties. METHODS The CSI-C was formulated through forward and backward translation, panel review and piloting and then validated among patients with chronic pain (n = 235). Its internal consistency, test-retest reliability, and concurrent validity were measured. An exploratory factor analysis (EFA) was performed for the construct validity. Receiver operating characteristic (ROC) analysis was employed to determine the discriminative ability in the presence of comorbidity of CSSs. RESULTS About 70% of the participants in the study experienced at least mild CS symptoms. CSI-C demonstrates a high internal consistency (Cronbach's alpha = 0.896) and excellent test-retest reliability (ICC = 0.932). CSI-C scoring was significantly correlated with pain intensity (r = 0.188), EQ-5D index (r = -0.375), anxiety (r=0.525), and depression (r = 0.467). The EFA generated a 5-factor model, including physical symptoms, emotional distress, hypersensitivity syndromes and so on. An CSI cutoff of 42 had a sensitivity of 71.4% and a specificity of 70% for identifying chronic pain patients with ≥2 CSSs. CONCLUSION The CS manifestations are prevalent in those with persistent pain. CSI-C is a reliable and valid instrument for measuring CS. A CSI score ≥42 may predict the comorbidity of 2 or above CSSs in patients with chronic pain.
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Affiliation(s)
- Beibei Feng
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, People’s Republic of China
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Xiaoqian Hu
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - William Weijia Lu
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Yuling Wang
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, People’s Republic of China
| | - Wing Yuk Ip
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
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Grant S, Norton S, Weiland RF, Scheeren AM, Begeer S, Hoekstra RA. Autism and chronic ill health: an observational study of symptoms and diagnoses of central sensitivity syndromes in autistic adults. Mol Autism 2022; 13:7. [PMID: 35164862 PMCID: PMC8842858 DOI: 10.1186/s13229-022-00486-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 01/24/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Autistic adults, particularly women, are more likely to experience chronic ill health than the general population. Central sensitivity syndromes (CSS) are a group of related conditions that are thought to include an underlying sensitisation of the central nervous system; heightened sensory sensitivity is a common feature. Anecdotal evidence suggests autistic adults may be more prone to developing a CSS. This study aimed to investigate the occurrence of CSS diagnoses and symptoms in autistic adults, and to explore whether CSS symptoms were related to autistic traits, mental health, sensory sensitivity, or gender. METHODS The full sample of participants included 973 autistic adults (410 men, 563 women, mean age = 44.6) registered at the Netherlands Autism Register, who completed questionnaires assessing autistic traits, sensory sensitivity, CSS, physical and mental health symptoms. The reliability and validity of the Central Sensitization Inventory (CSI) in an autistic sample was established using exploratory and confirmatory factor analyses. Chi2 analyses, independent t-tests, hierarchical regression and path analysis were used to analyse relationships between CSS symptoms, autistic traits, measures of mental health and wellbeing, sensory sensitivity, age and gender. RESULTS 21% of participants reported one or more CSS diagnosis, and 60% scored at or above the clinical cut-off for a CSS. Autistic women were more likely to report a CSS diagnosis and experienced more CSS symptoms than men. Sensory sensitivity, anxiety, age and gender were significant predictors of CSS symptoms, with sensory sensitivity and anxiety fully mediating the relationship between autistic traits and CSS symptoms. LIMITATIONS Although this study included a large sample of autistic adults, we did not have a control group or a CSS only group. We also could not include a non-binary group due to lack of statistical power. CONCLUSIONS CSS diagnoses and symptoms appear to be very common in the autistic population. Increased awareness of an association between autism and central sensitisation should inform clinicians and guide diagnostic practice, particularly for women where CSS are common and autism under recognised.
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Affiliation(s)
- Sarah Grant
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Ricarda F. Weiland
- Faculty of Behavioural and Movement Sciences, Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Anke M. Scheeren
- Faculty of Behavioural and Movement Sciences, Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Sander Begeer
- Faculty of Behavioural and Movement Sciences, Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Rosa A. Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
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Metri S, Pourmand A, Beisenova K, Shesser R. The recognition of Central Sensitization Syndrome in the Emergency Department. Am J Emerg Med 2021; 57:166-168. [PMID: 34895952 DOI: 10.1016/j.ajem.2021.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Samer Metri
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Kamilla Beisenova
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Robert Shesser
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
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