1
|
Hooker JE, Brewer JR, McDermott K, Kanaya M, Somers TJ, Keefe F, Kelleher S, Fisher HM, Burns J, Wilson R, Kulich R, Polykoff G, Parker RA, Greenberg J, Vranceanu AM. Improving multimodal physical function in adults with heterogeneous chronic pain; Protocol for a multisite feasibility RCT. Contemp Clin Trials 2024; 138:107462. [PMID: 38286223 PMCID: PMC10932927 DOI: 10.1016/j.cct.2024.107462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/27/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Chronic pain is associated with substantial impairment in physical function, which has been identified as a top concern among persons with pain. GetActive-Fitbit, a mind-body activity program, is feasible, acceptable, and associated with improvement in physical function among primarily White, sedentary individuals with pain. In preparation for a multisite efficacy trial, we must examine feasibility across multiple sites with diverse patient populations. Here we describe the protocol of a multisite, feasibility RCT comparing GetActive-Fitbit with a time- and attention-matched educational comparison (Healthy Living for Pain). We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including recruitment of chronic pain patients taking <5000 steps/day and racial and ethnic minorities; and 3) optimize fidelity and study protocol in preparation for a future multisite efficacy trial. METHODS Clinician training fidelity was assessed via roleplays and mock group sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings. RESULTS The trial is ongoing. Clinician training is complete. 87 participants have been recruited. 54 completed baseline assessments and randomization, 44 are mid-intervention, and 9 have completed the intervention and posttest. CONCLUSIONS This study addresses the critical need for feasible, acceptable mind-body-activity interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. Results will inform a future fully-powered multisite efficacy trial. CLINICAL TRIAL REGISTRATION NCT05700383.
Collapse
Affiliation(s)
- Julia E. Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Julie R. Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Millan Kanaya
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Tamara J. Somers
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Francis Keefe
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Sarah Kelleher
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Hannah M. Fisher
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - John Burns
- Rush University, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Rebecca Wilson
- Rush University, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Rush University, Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Ronald Kulich
- Harvard Medical School, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United State
| | - Gary Polykoff
- Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States
| | - Robert A. Parker
- Biostatistics Center, Massachusetts General Hospital, Boston, MA United States
| | | | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| |
Collapse
|
2
|
McDermott K, Levey N, Brewer J, Ehmann M, Hooker JE, Pasinski R, Yousif N, Raju V, Gholston M, Greenberg J, Ritchie CS, Vranceanu AM. Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic. JMIR Res Protoc 2023; 12:e52117. [PMID: 38157234 PMCID: PMC10787331 DOI: 10.2196/52117] [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: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). OBJECTIVE We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. METHODS We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). RESULTS We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. CONCLUSIONS We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52117.
Collapse
Affiliation(s)
- Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nadine Levey
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Madison Ehmann
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Roger Pasinski
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Neda Yousif
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Vidya Raju
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Milton Gholston
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christine S Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| |
Collapse
|
3
|
Cardle P, Kumar S, Leach M, McEvoy M, Veziari Y. Mindfulness and Chronic Musculoskeletal Pain: An Umbrella Review. J Multidiscip Healthc 2023; 16:515-533. [PMID: 36879651 PMCID: PMC9985422 DOI: 10.2147/jmdh.s392375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 03/04/2023] Open
Abstract
Background Chronic musculoskeletal pain (CMSP) disorders are a leading cause of disability globally, affecting up to one in three people. Mindfulness-based interventions (MBI) have become a popular treatment for CMSP. The aim of this umbrella review was to synthesise the best available research evidence for the effectiveness of MBI for adults with CMSP. Methods Eight databases were searched from inception to 30th June 2021 for systematic reviews that examined the use of MBI in CMSP (pain experienced >3 months) in adult populations. Two reviewers independently conducted screening and selection, data extraction, and assessment of methodological quality using The Assessing the Methodological Quality of Systematic Reviews tool (AMSTAR 2). Outcomes examined were pain, sleep quality, depression, quality of life, physical functioning, and mindfulness. Furthermore, definitions of mindfulness, and intervention parameters (mindfulness practices used, length, frequency of sessions, duration) were also reported. Results Nineteen systematic reviews (n = 1 rated high quality, n = 1 moderate quality, n = 2 low quality and n = 15 critically low quality) examining 194 primary studies met the review criteria. Although some promising evidence was identified for the use of MBI in CMSP, the general low quality and widespread heterogeneity of included SRs and made it difficult to reach a definitive conclusion. Differences in results and outcomes amongst systematic reviews that, in many cases, had a high overlap of included RCTs, suggests fundamental differences in critical design elements that make data difficult to compare. Conclusion This umbrella review found mixed results on the effectiveness of MBI for the management of CMSP across a range of outcomes (pain, sleep quality, depression, quality of life, physical functioning, mindfulness). Definitions of MBI varied as did parameters, which may have contributed to these mixed results. More rigorous research with stringent MBI protocols is required.
Collapse
Affiliation(s)
- Paul Cardle
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Saravana Kumar
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Maureen McEvoy
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Yasamin Veziari
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
4
|
Norman-Nott N, Hesam-Shariati N, Cashin AG, Wewege MA, Rizzo RR, Wilks CR, Quidé Y, McAuley J, Gustin SM. Evaluation of emotion-centric psychological interventions for chronic pain: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e063102. [PMID: 36351710 PMCID: PMC9644329 DOI: 10.1136/bmjopen-2022-063102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Chronic pain, defined as pain persisting longer than 3 months, is more than an unpleasant sensory experience. Persistent negative emotions and emotional comorbidities, such as depression and anxiety, plague people with chronic pain leading to worsening pain intensity and increasing disability. While cognitive-behavioural therapy (CBT) is the gold standard psychological treatment, recent evidence highlights that CBT lacks efficacy for the physical and emotional aspects of chronic pain. Increasingly, researchers are investigating emotion-centric psychological therapies. While treatment modalities vary, these interventions frequently target understanding emotions, and train individuals for an emotionally adaptive response. The aim of this systematic review and meta-analysis is to quantify the efficacy of emotion-centric interventions for the physical and emotional characteristics of chronic pain. METHODS/ANALYSIS Electronic databases (EMBASE, PubMed, PsychINFO, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science) will be systematically searched from inception to 28 April 2022 for randomised controlled trials. Studies that compare an emotion-centric intervention with another form of treatment or placebo/control for adults (≥18 years old) with chronic pain will be included. All treatment modes (eg, online or in-person), any duration and group-based or individual treatments will be included. Studies that do not investigate at least one emotion-centric treatment will be excluded. The primary outcome is pain intensity. Secondary outcomes include emotion dysregulation, depression, anxiety, affect, safety and intervention compliance. A quantitative synthesis using a random effects meta-analysis will be adopted. Risk of bias will be evaluated using Cochrane Risk of Bias V.2.0 with the certainty of evidence assessed according to Recommendation, Assessment, Development and Evaluation. Data permitting, subgroup analysis will be conducted for intervention type and pain condition. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. Results may inform an efficacy study examining a new emotion-centric intervention for chronic pain. Dissemination will be through peer-reviewed publications and in conference presentations. PROSPERO REGISTRATION NUMBER CRD42021266815.
Collapse
Affiliation(s)
- Nell Norman-Nott
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Negin Hesam-Shariati
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rodrigo Rn Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Chelsey R Wilks
- Department of Psychological Science, University of Missouri, St Louis, Missouri, USA
| | - Yann Quidé
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - James McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sylvia Maria Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| |
Collapse
|
5
|
Grunberg VA, Greenberg J, Mace RA, Bakhshaie J, Choi KW, Vranceanu AM. Fitbit Activity, Quota-Based Pacing, and Physical and Emotional Functioning Among Adults With Chronic Pain. THE JOURNAL OF PAIN 2022; 23:1933-1944. [PMID: 35914640 PMCID: PMC10226285 DOI: 10.1016/j.jpain.2022.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/14/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
Physical activity can improve function in patients with chronic pain, however, adherence is low, in part due to inconsistent activity patterns. Smart wearable activity trackers, such as Fitbits, may help promote activity. In our program for chronic pain, we examined: 1) Fitbit activity patterns (ie, step count, moderate-to-vigorous physical activity (MVPA), sedentary behavior), and 2) whether achievement of weekly, individualized Fitbit step goals was associated with functional outcomes. We conducted a secondary analysis of Fitbit data from our 10-week mind-body activity program for chronic pain (GetActive-Fitbit arm, N = 41). Participants self-reported emotional and physical function and completed performance-based and accelerometer-based assessments. From week 1 to week 10, 30% of participants increased >800 steps; 32.5% increased MVPA; and 30% decreased sedentary behavior. Only step count significantly changed across time with mean steps peaking at week 8 (M = +1897.60, SD = 467.67). Fitbit step goal achievement was associated with improvements in anxiety (ß = -.35, CI [-2.80, -.43]), self-reported physical function (ß = -.34, CI [-5.17, 8.05]), and performance-based physical function (ß = .29, CI [-71.93, 28.38]), but not accelerometer-based physical function or depression. Adhering to individualized Fitbit step goals in the context of a mind-body activity program may improve anxiety and self-reported and performance-based physical function. PERSPECTIVE: We examine Fitbit activity patterns and the association between quota-based pacing and functional outcomes within a mind-body activity program for adults with chronic pain. Complementing quota-based pacing and coping skills with Fitbits may be a useful approach to promote activity engagement and behavior change in chronic pain populations.
Collapse
Affiliation(s)
- Victoria A Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Newborn Medicine, MassGeneral for Children, Boston, Massachusetts
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Karmel W Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
6
|
Lovette BC, Kanaya MR, Bannon SM, Vranceanu AM, Greenberg J. "Hidden gains"? Measuring the impact of mindfulness-based interventions for people with mild traumatic brain injury: a scoping review. Brain Inj 2022; 36:1059-1070. [PMID: 36003005 PMCID: PMC9481709 DOI: 10.1080/02699052.2022.2109745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 08/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Mindfulness-based interventions can support recovery from mild traumatic brain injury (mTBI). Although measurement is a key determinant of outcomes, there is no comprehensive assessment of measurement approaches used to capture outcomes of these programs. Here, we review the domains targeted, measurement techniques used, and domains and techniques most affected by mindfulness-based interventions for mTBI. METHODS We conducted a scoping review. After screening and full-text review, we included 29 articles and extracted data related to measurement domains, techniques, and results. RESULTS We identified 8 outcome domains, each with multiple subdomains. The most common domains were cognitive symptoms and general health/quality of life. No quantitative studies directly assessed sleep, physical-function, or pain-catastrophizing. Self-report was the most common measurement technique, followed by performance-based methods. Coping, somatic symptoms, emotional symptoms, stress response, and domains of cognition (particularly attention) were the most frequently improved domains. Qualitative results described benefits across all domains and suggested novel areas of benefit. Biomarkers did not reflect significant change. CONCLUSIONS Mindfulness-based interventions for mTBI impact a range of clinical domains and are best captured with a combination of measurement approaches. Using qualitative methods and expanding the breadth of outcomes may help capture underexplored effects of mindfulness-based interventions for mTBI.
Collapse
Affiliation(s)
- Brenda C. Lovette
- MGH Institute of Health Professions, Boston, MA, USA
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Millan R. Kanaya
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah M. Bannon
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Mindfulness-Based Stress Reduction in Breast Cancer Survivors with Chronic Neuropathic Pain: A Randomized Controlled Trial. Pain Res Manag 2022; 2022:4020550. [PMID: 35845983 PMCID: PMC9282981 DOI: 10.1155/2022/4020550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/21/2022] [Indexed: 11/17/2022]
Abstract
Objectives The purpose of this study was to compare the effects of group-delivered mindfulness-based stress reduction as compared to a waitlist control group among breast cancer survivors living with CNP. Methods A randomized controlled trial design was applied, and outcomes collected included pain, emotional function, quality of life, and global impression of change. Results A total of 98 women were randomized and included in analyses. The sample included 49 women in the mindfulness-based stress reduction group, and 49 women in the waitlist control group. The intervention group participants (mean age 51.3 years, standard deviation = 11.4) and waitlist participants (mean age 55.1 years, standard deviation = 9.6) reported an average pain duration of approximately three years. No significant differences were found on the primary outcome of the proportions of women with reduced pain interference scores from the time of randomization to 3 months after the intervention was received. No significant changes were found among secondary outcomes. Conclusion Our randomized clinical trial did not find significant benefits of group-based mindfulness-based stress reduction for the management of CNP. The current study findings should be replicated and are important to consider given ongoing concerns that nonsignificant results of mindfulness-based stress reduction are often unpublished.
Collapse
|
8
|
Moreira MF, Gamboa OL, Pinho Oliveira MA. A Single-blind, randomized, pilot study of a brief Mindfulness-Based Intervention for the endometriosis-related pain management. Eur J Pain 2022; 26:1147-1162. [PMID: 35276031 DOI: 10.1002/ejp.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Women with endometriosis suffer from frequent symptoms despite multiple treatments in tertiary care. Although there is a need for a biopsychosocial perspective on endometriosis treatment, few conservative treatments have been investigated. We aimed to investigate the effects of a brief Mindfulness-Based Intervention (bMBI) in women with deep endometriosis who remain symptomatic despite undergoing conventional medical treatment. METHODS A randomized controlled trial was performed with 2 groups: a standard medical treatment plus bMBI program and only standard medical treatment as a control. A total of 63 eligible participants were randomized to bMBI and control group. The primary outcome was endometriosis-related pain, and secondary outcomes were quality of life and stress perception posttreatment. Analyses were carried out using multiple regression models. RESULTS The results show that bMBI significantly improved pain unpleasantness (Cohen's f2 = 0.67, NNT = 3.2), pelvic pain (Cohen's f2 = 0.16, NNT = 5.3), and dyschezia (Cohen's f2 = 0.23, NNT = 2.9) immediately posttreatment and decreased all endometriosis-related pain (Cohen's f2 ranging from 0.20 to 0.60 and NNT ranging from 5 to -9) after the follow-up. We found an extensive positive effect of bMBI on the mental health dimension in the two time-point measures (Cohen's f2 = 0.34 and 0.25, NNT = 3.5 and 2.3) and vitality (Cohen's f2 = 0.22, NNT = 2.1) after the follow-up. CONCLUSIONS Our study suggests that bMBI is useful for managing endometriosis-related pain and restoring women's psychological well-being.
Collapse
Affiliation(s)
- Marcelo França Moreira
- State University of Rio de Janeiro, Faculty of Medical Sciences, Avenida Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Olga Lucia Gamboa
- EQness.,School of Psychology, A19 - Griffith Taylor Building, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Marco Aurelio Pinho Oliveira
- Department of Gynecology, State University of Rio de Janeiro, Avenida Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| |
Collapse
|
9
|
Ding D, Zheng M. Associations Between Six Core Processes of Psychological Flexibility and Functioning for Chronic Pain Patients: A Three-Level Meta-Analysis. Front Psychiatry 2022; 13:893150. [PMID: 35898622 PMCID: PMC9309299 DOI: 10.3389/fpsyt.2022.893150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.
Collapse
Affiliation(s)
- Dongyan Ding
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Mengna Zheng
- School of Educational Science, Anhui Normal University, Wuhu, China
| |
Collapse
|
10
|
Greenberg J, Lin A, Popok PJ, Kulich RJ, Edwards RR, Vranceanu AM. Getting Active Mindfully: Rationale and Case Illustration of a Group Mind-body and Activity Program for Chronic Pain. J Clin Psychol Med Settings 2021; 28:706-719. [PMID: 33469845 PMCID: PMC8411352 DOI: 10.1007/s10880-020-09758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Chronic pain is associated with substantial decreases in physical and emotional health. Psychosocial and physical restoration interventions, although potentially helpful, typically show small-to-moderate improvements that are limited to the short term, and often exhibit problematic adherence. Here, we present GetActive-Fitbit, a novel 10-week group program that integrates mind-body skills, pain coping and gradual increases in activity reinforced by a commercially available digital monitoring device (Fitbit). We illustrate the program among a group of 4 adults with heterogeneous chronic pain. We also highlight pre to post-program improvements in physical function (objective, performance-based and self-report), emotional function (depression and anxiety) and other relevant outcomes targeted by the program (e.g., pain intensity, catastrophizing, mindfulness, coping, kinesiophobia, emotional support, social isolation, pain resilience, program satisfaction and impression of change). Group participants' experiences suggest that GetActive-Fitbit is credible, useful, and shows potential to improve physical and emotional function among this challenging population.Clinical trial number: NCT03412916.
Collapse
Affiliation(s)
- Jonathan Greenberg
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ann Lin
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Paula J Popok
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, USA
- Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert R Edwards
- Harvard Medical School, Boston, MA, USA
- Pain Management Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
11
|
Weigand R, Moosmayer A, Jacobsen T. Does self-reported chronic pain influence savoring of aesthetic experiences? PLoS One 2021; 16:e0259198. [PMID: 34767583 PMCID: PMC8589147 DOI: 10.1371/journal.pone.0259198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aesthetic experiences elicit a wide range of positive emotions and have a positive impact on various health outcomes. In this context, savoring refers to a cognitive form of emotion regulation used to maintain and extend positive emotional experiences and is considered to contribute to health and well-being. Chronic pain has been linked to reduced reward-seeking behavior. This is the first study to investigate the relationship between self-reported chronic pain and savoring. METHODS We conducted an anonymous cross-sectional survey in a large non-clinical sample (opera, theater, and cabaret visitors; n = 322). The variables were assessed with a two-item-questionnaire. RESULTS Self-reported chronic pain was significantly negatively correlated with savoring (r = -.547). CONCLUSION Altogether, this result helps to develop a better understanding of the effects of chronic pain in humans and to shed light on state-dependent differences in aesthetic experiences.
Collapse
Affiliation(s)
- Rosalie Weigand
- Experimental Psychology Unit, Humanities and Social Sciences, Helmut Schmidt University / University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Annika Moosmayer
- Experimental Psychology Unit, Humanities and Social Sciences, Helmut Schmidt University / University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Thomas Jacobsen
- Experimental Psychology Unit, Humanities and Social Sciences, Helmut Schmidt University / University of the Federal Armed Forces Hamburg, Hamburg, Germany
| |
Collapse
|
12
|
Resistance training reduces pain indices and improves quality of life and body strength in women with migraine disorders. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00822-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity. J Pers Med 2021; 11:jpm11080810. [PMID: 34442454 PMCID: PMC8401554 DOI: 10.3390/jpm11080810] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.
Collapse
|
14
|
Popok PJ, Greenberg J, Gates MV, Vranceanu AM. A qualitative investigation of activity measurement and change following a mind-body activity program for chronic pain. Complement Ther Clin Pract 2021; 44:101410. [PMID: 33971485 PMCID: PMC8328925 DOI: 10.1016/j.ctcp.2021.101410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Increasing activity is important yet challenging among people with chronic pain. Objective assessment of activity using accelerometers (i.e., ActiGraph) has gained popularity, but reactivity to assessment and non-adherence to wearing the ActiGraph may bias data. We explored: 1) experiences of wearing the ActiGraph to identify ways to increase adherence and facilitate accurate assessment of activity; and 2) barriers and facilitators to increasing activity following two mind-body activity programs to optimize future interventions. We conducted semi-structured exit interviews with 13 participants with heterogenous chronic pain who completed a randomized controlled trial of two mind-body activity programs. We analyzed transcripts using a framework approach to generate themes. Participants indicated that receiving reminders increased ActiGraph wear adherence and reported that program skills such as gratitude, pacing, mindfulness, and deep breathing were facilitators to increasing activity, while medical problems were barriers. Interventions aiming to increase activity may benefit from emphasizing mind-body skills and sending ActiGraph wear reminders.
Collapse
Affiliation(s)
- Paula J Popok
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Melissa V Gates
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
15
|
Bigalke S, Maeßen TV, Schnabel K, Kaiser U, Segelcke D, Meyer-Frießem CH, Liedgens H, Macháček PA, Zahn PK, Pogatzki-Zahn EM. Assessing outcome in postoperative pain trials: are we missing the point? A systematic review of pain-related outcome domains reported in studies early after total knee arthroplasty. Pain 2021; 162:1914-1934. [PMID: 33492036 DOI: 10.1097/j.pain.0000000000002209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 01/04/2023]
Abstract
ABSTRACT The management of acute postoperative pain remains suboptimal. Systematic reviews and Cochrane analysis can assist with collating evidence about treatment efficacy, but the results are limited in part by heterogeneity of endpoints in clinical trials. In addition, the chosen endpoints may not be entirely clinically relevant. To investigate the endpoints assessed in perioperative pain trials, we performed a systematic literature review on outcome domains assessing effectiveness of acute pain interventions in trials after total knee arthroplasty. We followed the Cochrane recommendations for systematic reviews, searching PubMed, Cochrane, and Embase, resulting in the screening of 1590 potentially eligible studies. After final inclusion of 295 studies, we identified 11 outcome domains and 45 subdomains/descriptors with the domain "pain"/"pain intensity" most commonly assessed (98.3%), followed by "analgesic consumption" (88.8%) and "side effects" (75.3%). By contrast, "physical function" (53.5%), "satisfaction" (28.8%), and "psychological function" (11.9%) were given much less consideration. The combinations of outcome domains were inhomogeneous throughout the studies, regardless of the type of pain management investigated. In conclusion, we found that there was high variability in outcome domains and inhomogeneous combinations, as well as inconsistent subdomain descriptions and utilization in trials comparing for effectiveness of pain interventions after total knee arthroplasty. This points towards the need for harmonizing outcome domains, eg, by consenting on a core outcome set of domains which are relevant for both stakeholders and patients. Such a core outcome set should include at least 3 domains from 3 different health core areas such as pain intensity, physical function, and one psychological domain.
Collapse
Affiliation(s)
- Stephan Bigalke
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | - Timo V Maeßen
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Kathrin Schnabel
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Ulrike Kaiser
- University Pain Centre, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Daniel Segelcke
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Christine H Meyer-Frießem
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | | | - Philipp A Macháček
- Faculty of Electrical Engineering and Information Technology, Ruhr-University Bochum, Bochum, Germany
| | - Peter K Zahn
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | - Esther M Pogatzki-Zahn
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| |
Collapse
|
16
|
Burgess DJ, Evans R, Allen KD, Bangerter A, Bronfort G, Cross LJ, Ferguson JE, Haley A, Hagel Campbell EM, Mahaffey MR, Matthias MS, Meis LA, Polusny MA, Serpa JG, Taylor SL, Taylor BC. Learning to Apply Mindfulness to Pain (LAMP): Design for a Pragmatic Clinical Trial of Two Mindfulness-Based Interventions for Chronic Pain. PAIN MEDICINE 2021; 21:S29-S36. [PMID: 33313730 DOI: 10.1093/pm/pnaa337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) are evidence-based nonpharmacological treatments for treating chronic pain. However, the predominant MBI, mindfulness-based stress reduction, has features that pose significant implementation barriers. OBJECTIVES This study will test two approaches to delivering MBIs for improving Veterans' chronic pain and mental health comorbidities. These two approaches address key implementation barriers. METHODS We will conduct a four-site, three-arm pragmatic randomized controlled trial, Learning to Apply Mindfulness to Pain (LAMP), to test the effectiveness of two MBIs at improving pain and mental health comorbidities. Mobile+Group LAMP consists of prerecorded modules presented by a mindfulness instructor that are viewed in an online group setting and interspersed with discussions led by a facilitator. Mobile LAMP consists of the same prerecorded modules but does not include a group component. We will test whether either of these MBIs will be more effective than usual care at improving chronic pain and whether the Mobile+Group LAMP will be more effective than Mobile LAMP at improving chronic pain. Comparisons for the primary hypotheses will be conducted with continuous outcomes (Brief Pain Inventory interference score) repeated at 10 weeks, 6 months, and 12 months. The secondary hypotheses are that Mobile+Group LAMP and Mobile LAMP will be more effective than usual care at improving secondary outcomes (e.g., post-traumatic stress disorder, depression). We will also confirm the comparisons for the primary and secondary hypotheses in gender-specific strata. IMPLICATIONS This trial is expected to result in two approaches for delivering MBIs that will optimize engagement, adherence, and sustainability and be able to reach large numbers of Veterans.
Collapse
Affiliation(s)
- Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| | - Roni Evans
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing.,School of Nursing, University of Minnesota
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System.,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | - Ann Bangerter
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - Gert Bronfort
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing.,School of Nursing, University of Minnesota
| | - Lee J Cross
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - John E Ferguson
- University of Minnesota Medical School.,Minneapolis VA Medical Center
| | - Alex Haley
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing.,School of Nursing, University of Minnesota
| | - Emily M Hagel Campbell
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - Mallory R Mahaffey
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA
| | - Marianne S Matthias
- Center for Health Information and Communication, Roudebush VA Medical Center.,Regenstrief Institute.,Indiana University School of Medicine
| | - Laura A Meis
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| | - Melissa A Polusny
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| | - J Greg Serpa
- Greater Los Angeles VA Healthcare System, Los Angeles, California, USA.,Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA School of Public Health and UCLA School of Medicine, Los Angeles, California, USA
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research, VA Medical Center, Minneapolis, USA.,University of Minnesota Medical School
| |
Collapse
|
17
|
Abbey H, Nanke L, Brownhill K. Developing a psychologically-informed pain management course for use in osteopathic practice: The OsteoMAP cohort study. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
18
|
Greenberg J, Mace RA, Bannon SM, Kulich RJ, Vranceanu AM. Mind-Body Activity Program for Chronic Pain: Exploring Mechanisms of Improvement in Patient-Reported, Performance-Based and Ambulatory Physical Function. J Pain Res 2021; 14:359-368. [PMID: 33574699 PMCID: PMC7872894 DOI: 10.2147/jpr.s298212] [Citation(s) in RCA: 6] [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: 12/24/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Improving physical function among patients with chronic pain is critical for reducing disability and healthcare costs. However, mechanisms underlying improvement in patient-reported, performance-based, and ambulatory physical function in chronic pain remain poorly understood. PURPOSE To explore psychosocial mediators of improvement in patient-reported, performance-based, and objective/accelerometer-measured physical function among participants in a mind-body activity program. METHODS Individuals with chronic pain were randomized to one of two identical 10-week mind-body activity interventions aimed at improving physical function with (GetActive-Fitbit; N=41) or without (GetActive; N=41) a Fitbit device. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step-count) measures of physical function, as well as measures of kinesiophobia (Tampa Kinesiophobia Scale), mindfulness (CAMS-R), and pain resilience (Pain Resilience Scale) before and after the intervention. We conducted secondary data analyses to test mediation via mixed-effects modeline. RESULTS Improvements in patient-reported physical function were fully and uniquely mediated by kinesiophobia (Completely Standardized Indirect Effect (CSIE)=.18; CI=0.08, 0.30; medium-large effect size), mindfulness (CSIE=-.14; CI=-25, -.05; medium effect size) and pain resilience (CSIE=-.07; CI=-.16, -.005; small-medium effect size). Improvements in performance-based physical function were mediated only by kinesiophobia (CSIE=-.11; CI=-23, -.008; medium effect size). No measures mediated improvements in objective (accelerometer measured) physical function. CONCLUSION Interventions aiming to improve patient-reported physical function in patients with chronic pain may benefit from skills that target kinesiophobia, mindfulness, and pain resilience, while those focused on improving performance-based physical function should target primarily kinesiophobia. More research is needed to understand mechanisms of improvement in objective, accelerometer-measured physical function. TRIAL REGISTRATION ClinicalTrials.gov NCT03412916.
Collapse
Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, USA
- Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | |
Collapse
|
19
|
Meehan E, Carter B. Moving With Pain: What Principles From Somatic Practices Can Offer to People Living With Chronic Pain. Front Psychol 2021; 11:620381. [PMID: 33569028 PMCID: PMC7868595 DOI: 10.3389/fpsyg.2020.620381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
This article brings together research from the fields of chronic pain management and somatic practices to develop a novel framework of principles to support people living with persistent pain. These include movement-based approaches to awareness of the internal body (interoception), the external environment (exteroception) and movement in space (proprioception). These significantly work with the lived subjective experiences of people living with pain, to become aware of body signals and self-management of symptoms, explore fear and pleasure of movement, and understand how social environments impact on pain. This analysis has potential to create new ways of supporting, understanding and articulating pain experiences, as well as shaping the future of somatic practices for chronic pain.
Collapse
Affiliation(s)
- Emma Meehan
- Centre for Dance Research, Coventry University, Coventry, United Kingdom
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| |
Collapse
|
20
|
Greenberg J, Mace RA, Popok PJ, Kulich RJ, Patel KV, Burns JW, Somers TJ, Keefe FJ, Schatman ME, Vranceanu AM. Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain. J Pain Res 2020; 13:2255-2265. [PMID: 32982388 PMCID: PMC7498493 DOI: 10.2147/jpr.s266455] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures. PURPOSE To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement. METHODS Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based 6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function. RESULTS Performance-based and objective physical function were significantly interrelated (r=0.48, p<0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (β=0.68, p<0.001), adaptive coping (β=-0.65, p<0.001) and social-emotional dysfunction (β=0.65, p<0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps>0.1). CONCLUSION Results suggest that patient-reported physical function may provide limited information about patients' physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity. TRIAL REGISTRATION ClinicalTrials.gov NCT03412916.
Collapse
Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, USA
- Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kushang V Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - John W Burns
- Division of Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Tamara J Somers
- Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Francis J Keefe
- Department of Medicine, Duke University School of Medicine, Durham, NC, US
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Greenberg J, Popok PJ, Lin A, Kulich RJ, James P, Macklin EA, Millstein RA, Edwards RR, Vranceanu AM. A Mind-Body Physical Activity Program for Chronic Pain With or Without a Digital Monitoring Device: Proof-of-Concept Feasibility Randomized Controlled Trial. JMIR Form Res 2020; 4:e18703. [PMID: 32348281 PMCID: PMC7308894 DOI: 10.2196/18703] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic pain is associated with poor physical and emotional functioning. Nonpharmacological interventions can help, but improvements are small and not sustained. Previous clinical trials do not follow recommendations to comprehensively target objectively measured and performance-based physical function in addition to self-reported physical function. OBJECTIVE This study aimed to establish feasibility benchmarks and explore improvements in physical (self-reported, performance based, and objectively measured) and emotional function, pain outcomes, and coping through a pilot randomized controlled trial of a mind-body physical activity program (GetActive) with and without a digital monitoring device (GetActive-Fitbit), which were iteratively refined through mixed methods. METHODS Patients with chronic pain were randomized to the GetActive (n=41) or GetActive-Fitbit (n=41) programs, which combine relaxation, cognitive behavioral, and physical restoration skills and were delivered in person. They completed in-person assessments before and after the intervention. Performance-based function was assessed with the 6-min walk test, and step count was measured with an ActiGraph. RESULTS Feasibility benchmarks (eg, recruitment, acceptability, credibility, therapist adherence, adherence to practice at home, ActiGraph wear, and client satisfaction) were good to excellent and similar in both programs. Within each program, we observed improvement in the 6-min walk test (mean increase=+41 m, SD 41.15; P<.001; effect size of 0.99 SD units for the GetActive group and mean increase=+50 m, SD 58.63; P<.001; effect size of 0.85 SD units for the GetActive-Fitbit group) and self-reported physical function (P=.001; effect size of 0.62 SD units for the GetActive group and P=.02; effect size of 0.38 SD units for the GetActive-Fitbit group). The mean step count increased only among sedentary patients (mean increase=+874 steps for the GetActive group and +867 steps for the GetActive-Fitbit group). Emotional function, pain intensity, pain coping, and mindfulness also improved in both groups. Participants rated themselves as much improved at the end of the program, and those in the GetActive-Fitbit group noted that Fitbit greatly helped with increasing their activity. CONCLUSIONS These preliminary findings support a fully powered efficacy trial of the two programs against an education control group. We present a model for successfully using the Initiative on the Methods, Measurement, and Pain Assessment in Clinical Trials criteria for a comprehensive assessment of physical function and following evidence-based models to maximize feasibility before formal efficacy testing. TRIAL REGISTRATION ClinicalTrial.gov NCT03412916; https://clinicaltrials.gov/ct2/show/NCT03412916.
Collapse
Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, United States
- Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Peter James
- Harvard Medical School, Boston, MA, United States
- Department of Population Medicine, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Eric A Macklin
- Harvard Medical School, Boston, MA, United States
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Rachel A Millstein
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Robert R Edwards
- Harvard Medical School, Boston, MA, United States
- Pain Management Center, Brigham and Women's Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| |
Collapse
|
22
|
Greenberg J, Lin A, Zale EL, Kulich RJ, James P, Millstein RA, Shapiro H, Schatman ME, Edwards RR, Vranceanu AM. Development And Early Feasibility Testing Of A Mind-Body Physical Activity Program For Patients With Heterogeneous Chronic Pain; The GetActive Study. J Pain Res 2019; 12:3279-3297. [PMID: 31849515 PMCID: PMC6912090 DOI: 10.2147/jpr.s222448] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/10/2019] [Indexed: 01/20/2023] Open
Abstract
Background Increasing physical function is a challenging, yet imperative goal of pain management programs. Physical activity can improve physical function, but uptake is low due to chronic pain misconceptions, poor pain management skills, and doing too much too soon. Purpose To increase physical function by 1) adapting an evidence-based, group, mind-body program to address the needs of patients with heterogeneous chronic pain and to facilitate individually tailored quota-based pacing with a Fitbit (GetActive with Fitbit) or without it (GetActive) (phase 1), and 2) assessing preliminary feasibility benchmarks (phase 2). Methods We followed evidence based frameworks for developing interventions and for early feasibility testing. In phase 1 we conducted 4 focus groups with 22 patients with heterogeneous chronic pain and adapted the mind-body program. In phase 2 we conducted a nonrandomized pilot trial of the 2 programs (N=7 and 6) with qualitative exit interviews. Results Focus groups showed high interest in increasing activity, a preference for walking linked to pleasurable activities, using a Fitbit to track number of steps, and learning skills to manage pain and aid with increased activity. Both programs had good to excellent feasibility markers. Participation in both programs was associated with signal of improvements in physical and emotional function, as well as intervention targets. Exit interviews confirmed high satisfaction and suggested modification. Conclusion Results informed subsequent adaptations of the 2 programs and methodology for an ongoing pilot randomized controlled trial (RCT) of the 2 programs, necessary before an efficacy RCT of the 2 programs against an education control.
Collapse
Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Emily L Zale
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, USA.,Center For Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Peter James
- Harvard Medical School, Boston, MA, USA.,Department of Population Medicine, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Rachel A Millstein
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Hannah Shapiro
- Department of Biology, Tufts University, Medford, MA, USA
| | - Michael E Schatman
- Research and Network Development, Boston Pain Care, Waltham, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Robert R Edwards
- Harvard Medical School, Boston, MA, USA.,Pain Management Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Reward Processing under Chronic Pain from the Perspective of "Liking" and "Wanting": A Narrative Review. Pain Res Manag 2019; 2019:6760121. [PMID: 31149319 PMCID: PMC6501242 DOI: 10.1155/2019/6760121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/06/2019] [Accepted: 04/04/2019] [Indexed: 11/29/2022]
Abstract
The therapeutic goals of patients with chronic pain are not only to relieve pain but also to improve the quality of life. Chronic pain negatively affects various aspects of daily life, such as by decreasing the motivation to work and reward sensitivity, which may lead to difficulties in daily life or even unemployment. Human and animal studies have shown that chronic pain damages reward processing; the exploration of associated internal mechanisms may aid the development of treatments to repair this damage. Incentive salience theory, used widely to describe reward processing, divides this processing into “liking” (reward-induced hedonic sensory impact) and “wanting” (reward-induced motivation) components. It has been employed to explain pathological changes in reward processing induced by psychiatric disorders. In this review, we summarize the findings of studies of reward processing under chronic pain and examine the effects of chronic pain on “liking” and “wanting.” Evidence indicates that chronic pain compromises the “wanting” component of reward processing; we also discuss the neural mechanisms that may mediate this effect. We hope that this review aids the development of therapies to improve the quality of life of patients with chronic pain.
Collapse
|