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Altieri M, Sergi MR, Tommasi M, Santangelo G, Saggino A. The efficacy of telephone-delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta-analysis. J Clin Psychol 2024; 80:223-254. [PMID: 37428900 DOI: 10.1002/jclp.23563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/20/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
COVID-19 pandemic led to an increase of remote treatments, such as telephone-delivery cognitive behavioral therapy (T-CBT). To our knowledge, no meta-analyses studied the effect of T-CBT in chronic and/or mental illnesses on multiple psychological outcomes. Therefore, our study aims to evaluating the efficacy of T-CBT compared to other interventions (treatment as usual, TAU, or face-to-face CBT). Each effect size (ES) was calculated in Hedges' g and pooled together to produce a mean ES for each outcome (depression, anxiety, mental and physical QoL, worry, coping, and sleep disturbances). The meta-analysis included 33 studies with a randomized controlled trial design. A large ES was found when comparing the efficacy of T-CBT against TAU on depression (g = 0.84, p < 0.001), whereas a moderate ES was found on anxiety (g = 0.57; p < 0.001), and a small effect on mental quality of life (g = 0.33, p < 0.001), sleep disturbances (g = 0.37, p = 0.042), coping (g = 0.20, p = 0.016) and worry (g = 0.43, p = 0.001). The meta-analysis comparing the efficacy of T-CBT and CBT on depression revealed a not significant pooled ES (g = 0.06, p = 0.466). The results provided evidence that T-CBT could be to be more effective than TAU conditions in multiple psychological outcomes, and as efficient as face-to-face CBT in treating depression.
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Affiliation(s)
- Manuela Altieri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Maria R Sergi
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
| | - Marco Tommasi
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Aristide Saggino
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
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Feng HX, Wang MX, Zhao HM, Hou XX, Xu B, Gui Q, Wu GH, Dong XF, Xu QR, Shen MQ, Shi QR, Cheng QZ, Xue SR. Effect of cognitive behavioral intervention on anxiety, depression, and quality of life in patients with epilepsy. Am J Transl Res 2022; 14:5077-5087. [PMID: 35958485 PMCID: PMC9360885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of cognitive behavioral therapy (CBT) on quality of life, anxiety, and depression in patients with epilepsy. METHODS Each study subject was randomly assigned to a CBT (n=46) or control (n=49) group (1:1 ratio), and the first group underwent an 8-week CBT treatment. Anxiety, depression, and quality of life (QOLIE-31) were assessed at both baseline and endpoint using the Self-Rating Anxiety Scale (SAS), Hamilton Depression Scale (HDMA) and quality of life in Epilepsy-31 (QOLIE-31) scales. The statistical analyses included between-and within-group comparisons of the effects of CBT on these measures and associations with demographic and clinical variables. RESULTS No differences were found between variables at baseline (P>0.05). The repeated-measures analyses found that CBT group had greater improvement in depression score compared to the control group (P<0.05). The analysis of anxiety score showed that compared to the control group, CBT intervention had no statistical significance in the total anxiety population. However, the CBT intervention decreased anxiety in women and Combined-drug group (P<0.05). The CBT group had greater improvement in overall score, medication effect, and seizure worry score than the control group (P<0.05). Stratified analysis found total and medication effects score of CBT intervention group for the combined-drug group were higher than those of the single drug group (P<0.05). CONCLUSION Increases in overall scores, seizure worry, cognitive functioning, and medication effect were better in the CBT group. CBT can improve anxiety, depression, and quality of life in patients with epilepsy. Women and combined-drug patients with epilepsy benefit most from CBT.
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Affiliation(s)
- Hong-Xuan Feng
- Department of Neurology, The First Affiliated Hospital of Soochow UniversitySuzhou 215006, Jiangsu, China
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Mei-Xia Wang
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Hui-Min Zhao
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Xiao-Xia Hou
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Bo Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Qian Gui
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Guan-Hui Wu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Xiao-Feng Dong
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Qin-Rong Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Ming-Qiang Shen
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Qian-Ru Shi
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Qing-Zhang Cheng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, Jiangsu, China
| | - Shou-Ru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow UniversitySuzhou 215006, Jiangsu, China
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Morton L, Stelfox K, Beasley M, Jones GT, Macfarlane GJ, Murchie P, Paton J, Hollick R. Lessons from experiences of accessing healthcare during the pandemic for remobilizing rheumatology services: a national mixed methods study. Rheumatol Adv Pract 2022; 6:rkac013. [PMID: 35350717 PMCID: PMC8946474 DOI: 10.1093/rap/rkac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To understand the impact of the coronavirus disease 2019 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory musculoskeletal (MSK) conditions. Methods Three established cohorts that included individuals with axial SpA, psoriatic arthritis and MSK pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semistructured interviews. Results A total of 1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. A total of 57% of respondents had tried to access care since the start of the UK national lockdown. More than a quarter reported being unable to book any type of healthcare appointment. General practice appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinically vulnerable were associated with a greater likelihood of attempting to access healthcare. People not in work, those reporting anxiety or depression and poorer quality of life were less likely to be satisfied with remotely delivered healthcare. Participants valued clear, timely and transparent care pathways across primary care and specialist services. While remote consultations were convenient for some, in-person appointments enabled physical assessment and facilitated the development and maintenance of clinical relationships with care providers. Conclusions We identified patient factors that predict access to and satisfaction with care and aspects of care that patients value. This is important to inform remobilisation of rheumatology services to better meet the needs of patients.
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Affiliation(s)
- LaKrista Morton
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Kevin Stelfox
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Marcus Beasley
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Gareth T Jones
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Gary J Macfarlane
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen
| | - John Paton
- Scottish Patient Ambassador, National Rheumatoid Arthritis Society, Maidenhead, UK
| | - Rosemary Hollick
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
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Macfarlane GJ, Beasley M, Scott N, Chong H, McNamee P, McBeth J, Basu N, Hannaford PC, Jones GT, Keeley P, Prescott GJ, Lovell K. Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study). Ann Rheum Dis 2021; 80:903-911. [PMID: 33526434 PMCID: PMC8237175 DOI: 10.1136/annrheumdis-2020-219091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023]
Abstract
Objective Cognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk. Methods A population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment. Results 996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR 1.05; 95% CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI −£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention. Conclusions A short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP. Trial registration number ClinicalTrials.gov Registry (NCT02668003).
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Affiliation(s)
- Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Huey Chong
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - John McBeth
- Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Phil Keeley
- School of Nursing and Midwifery, University of Keele, Stoke-on-Trent, Staffordshire, UK
| | - Gordon J Prescott
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Davies AF, Hill P, Fay D, Dee A, Locher C. Body Reprogramming: Reframing the Fibromyalgia narrative and providing an integrative therapeutic model. Health Psychol Open 2020; 7:2055102920971494. [PMID: 35186312 PMCID: PMC8851147 DOI: 10.1177/2055102920971494] [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] [Indexed: 12/29/2022] Open
Abstract
We propose a theory known as the Hyland model to help conceptualise
Fibromyalgia within a complex adaptive control system. A fundamental
assumption is that symptom generating mechanisms are causally
connected, forming a network that has emergent properties. An illness
narrative has been developed which has a ‘goodness of fit’ with the
lived experience of those with Fibromyalgia. The theory guides
management within the clinical setting and incorporates current
evidence-based therapeutic strategies, within a multi-modal
intervention described as ‘Body Reprogramming’. This intervention
focuses on non-pharmacological and lifestyle-based considerations. The
theoretical framework also helps explain why modest therapeutic
effects are gained from current pharmacological options.
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Affiliation(s)
| | - Patrick Hill
- Sandwell and West Birmingham Hospitals NHS Trust, UK
| | | | - Annily Dee
- University Hospitals Plymouth NHS Trust, UK
| | - Cosima Locher
- Harvard Medical School, USA.,University of Plymouth, UK.,University of Basel, Switzerland
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Fraser C, Beasley M, Macfarlane G, Lovell K. Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability. BMC Musculoskelet Disord 2019; 20:198. [PMID: 31077168 PMCID: PMC6511117 DOI: 10.1186/s12891-019-2584-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background Telephone cognitive behavioural therapy (tCBT) is an acceptable and effective treatment for patients with chronic widespread pain (CWP). Preventing the onset of CWP offers considerable benefits to the individual and society and the MAmMOTH study is the first aimed at CWP prevention. The study is a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. This nested qualitative study explores patients’ treatment experiences, with a view to understanding their potential influences on acceptability of the intervention. Methods The MAmMOTH Study recruited 1002 participants, half of whom were randomised to receive tCBT. Participants were eligible for invitation to the trial if they had pain for which they had consulted their GP, or had pain and visited a doctor frequently, and had 2 of 3 risk factors for development of CWP. Participants randomised to tCBT who had completed treatment were eligible for invitation to qualitative interviews for this study. Individual qualitative interviews were conducted with a sub-sample (n = 33) of patients at high risk of developing CWP who had been allocated to the intervention arm. Semi-structured telephone interviews explored treatment experiences and intervention acceptability. Data was analysed using Framework analysis. Results Participants presented with a range of musculoskeletal and auto-immune conditions and almost half described their pain as ‘chronic’ on study entry. Many participants perceived the trial intervention to be aimed at treatment of pain rather than prevention of pain. Initial expectations prior to treatment varied, with scepticism more likely for those who had little prior knowledge of CBT approaches. All participants provided positive feedback post intervention particularly in relation to the modality, therapist experience and skills and the intervention. The majority of participants described positive changes in either their subjective level of pain or pain-management post-intervention and some attributed the positive change directly to the intervention as a result of empowerment, increased self-management and cognitive restructuring. Conclusions This study extends our understanding of the acceptability and suitability of preventative interventions for chronic widespread pain and provides further evidence for the acceptability of tCBT. Trial registration Clinical Trials.gov NCT02668003 (registered 29th January, 2016). Electronic supplementary material The online version of this article (10.1186/s12891-019-2584-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Fraser
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Marcus Beasley
- Medical Sciences and Nutrition, Health Sciences Building (1st floor), School of Medicine, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Gary Macfarlane
- Medical Sciences and Nutrition, Health Sciences Building (1st floor), School of Medicine, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Karina Lovell
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
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Salmon J. High-frequency spinal cord stimulation at 10 kHz for widespread pain: a retrospective survey of outcomes from combined cervical and thoracic electrode placements. Postgrad Med 2019; 131:230-238. [PMID: 30807247 DOI: 10.1080/00325481.2019.1587564] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To report on the long-term outcomes for patients receiving paraesthesia-free high-frequency spinal cord stimulation (HF10-SCS) at 10 kHz for the treatment of combined upper and lower body neuropathic/nociplastic pain syndromes including chronic widespread pain/fibromyalgia. MATERIALS AND METHODS Forty-five patients with widespread (both upper and lower body) neuropathic/nociplastic pain syndromes underwent a trial of combined cervical and thoracic HF10-SCS leads placed over the C2/T2 or C2/T9 vertebral levels, or three leads placed over the C2/T2/T9 vertebral levels. Thirty-eight patients proceeded to permanent implant, resulting in a trial to implant conversion rate of 84.4%. Patients were followed up an average of 2.3 ± 1.7 years post-permanent implant. Patient outcomes were recorded. RESULTS A statistically significant reduction of 3.5 ± 1.6 on the 10-point numerical rating scale (NRS) at 2.3 ± 1.7 years post-permanent implant was observed (baseline: 7.1 ± 0.8 vs. follow up: 3.7 ± 1.3) (p ≤ 001). Likewise, a reduction in disability (Roland Morris Disability Questionnaire) was also observed; baseline: 12.3 ± 5.1 vs. follow up: 7.8 ± 5.9. Similar trends were observed in a working capacity, with 20/31 (64.5%) of the work eligible patients employed at follow-up, compared with only 8/31 (25.8%) at baseline. Opioid pain medication use reduced and over 90% of patients were satisfied with their treatment outcome. No long-term adverse events were observed. CONCLUSIONS HF10-SCS at 10 kHz provides long-term widespread pain relief when leads are staggered across the cervical and thoracic spine. The improved return to work outcomes and opiate reductions suggest that cost-effectiveness as well as clinical effectiveness may be achieved with this treatment approach.
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Affiliation(s)
- John Salmon
- a PainCare Perth , Parkland House , Cottesloe , Australia
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Individual differences in pain: understanding the mosaic that makes pain personal. Pain 2018; 158 Suppl 1:S11-S18. [PMID: 27902569 DOI: 10.1097/j.pain.0000000000000775] [Citation(s) in RCA: 314] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Gellatly J, Pelikan G, Wilson P, Woodward-Nutt K, Spence M, Jones A, Lovell K. A qualitative study of professional stakeholders' perceptions about the implementation of a stepped care pain platform for people experiencing chronic widespread pain. BMC FAMILY PRACTICE 2018; 19:151. [PMID: 30172253 PMCID: PMC6119589 DOI: 10.1186/s12875-018-0838-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 08/20/2018] [Indexed: 12/02/2022]
Abstract
Background Chronic widespread pain (CWP) is a major public health problem. Many people experiencing CWP experience mental health problems such as anxiety or depression. Complete relief of skeletal and body pain symptoms is unlikely but with appropriate treatment the impact upon quality of life, functioning and mental health symptoms can be reduced. Cognitive behavioural therapy (CBT) is widely used for a range of health conditions and can have short and long-term improvements in patients with CWP. This research aimed to explore, from a professional stakeholder perspective, the implementation of a local Pain Platform offering a stepped care approach for interventions including telephone delivered CBT (T-CBT). Methods Fourteen professional stakeholders holding various roles across primary and secondary care services within the Pain Platform took part in semi-structured interviews. Their views and experiences of the implementation of the Pain Platform were explored. Interviews were recorded, transcribed verbatim and analysed according to Normalisation Process Theory (NPT). Results Professional stakeholders were positive about the Pain Platform and its potential to overcome previously identified existing access issues to psychological interventions for CWP patients. It was considered a valuable part of ensuring that patients’ preferences and needs are more readily addressed. In some circumstances, however, introducing psychological interventions to patients was considered challenging and the introduction of new referral processes was raised concerns. To ensure sustainability more work is required to reduce professional isolation and ensure efficient referral procedures between primary and secondary care services are established to reduce concerns over issues related to clinical governance and potential risk to patient. Conclusions The findings provide professional insight into the key challenges of introducing a Pain Platform incorporating psychological support across primary and secondary care services within a local service. These included development of sustainable procedures and closer working relationships. Areas requiring future development are identified.
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Affiliation(s)
- Judith Gellatly
- NIHR CLAHRC Greater Manchester, Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | | | - Paul Wilson
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Kate Woodward-Nutt
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Michael Spence
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anthony Jones
- Human Pain Research Group, Division of Neuroscience and Cognitive Psychology, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Karina Lovell
- NIHR CLAHRC Greater Manchester, Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Clauw DJ, D'Arcy Y, Gebke K, Semel D, Pauer L, Jones KD. Normalizing fibromyalgia as a chronic illness. Postgrad Med 2017; 130:9-18. [PMID: 29256764 DOI: 10.1080/00325481.2018.1411743] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.
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Affiliation(s)
- Daniel J Clauw
- a Department of Anesthesiology , University of Michigan , Ann Arbor , MI , USA
| | - Yvonne D'Arcy
- b Pain Management Nurse Practitioner , Ponte Vedra Beach , FL , USA
| | - Kevin Gebke
- c Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | | | | | - Kim D Jones
- f Schools of Nursing & Medicine , Oregon Health & Science University , Portland , OR , USA
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11
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Wilson IR. Management of chronic pain through pain management programmes. Br Med Bull 2017; 124:55-64. [PMID: 28927228 DOI: 10.1093/bmb/ldx032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic pain carries significant impact and is difficult to treat with limited success. Pain management programmes (PMPs) use cognitive behavioural therapy (CBT)-based multidisciplinary rehabilitative approaches to drive functional improvement. SOURCES OF DATA A search was conducted using Medline and the Cochrane Library to identify published literature about PMPs or CBT to treat chronic pain. AREAS OF AGREEMENT PMPs have significant benefit on functioning for some patients but relatively little impact on the pain. Not all patients, nor pain types, benefit. Around a third of patients show improvement, with considerable variability. AREAS OF CONTROVERSY There is much heterogeneity between approaches and outcomes measured, and the extent and duration of benefit is inconsistently reported. The investment required of patients, staff and commissioners is significant. Existing data provides limited information to judge whether PMPs represent good value for each of those stakeholders. GROWING POINTS The British Pain Society provide guidelines for PMPs, due for revision in 2018 which may provide opportunities for greater clarity and demonstrating value. Other approaches are emerging and being evaluated. AREAS TIMELY FOR DEVELOPING RESEARCH Participation may have more subjective impact than objective outcomes and merits qualitative research. With a (significant) minority of patients showing improvement, research into patient and treatment selection is essential alongside longterm outcomes and sustaining benefits.
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Affiliation(s)
- I R Wilson
- Pain Medicine and Anaesthesia, Trust Headquarters, Mid-Yorkshire Hospitals NHS Trust, Aberford Rd, Wakefield WF1 4DG, UK
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