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Emmet DK, Davis G, Pierce-Talsma S, Shubrook JH, Mehling W. Interoceptive bodily awareness in patients seeking pain relief with osteopathic manipulative treatment: an observational cohort pilot study. J Osteopath Med 2024; 0:jom-2022-0081. [PMID: 38650438 DOI: 10.1515/jom-2022-0081] [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: 04/23/2022] [Accepted: 02/14/2024] [Indexed: 04/25/2024]
Abstract
CONTEXT Interoceptive bodily awareness (IBA) is one's attentional focus on and relationship with comfortable and uncomfortable (e.g., pain) internal body sensations. Integrating IBA into research on osteopathic manipulative treatment (OMT) is growing, both as an outcome and predictor of treatment outcomes; however, it has yet to be studied in a clinical setting. OBJECTIVES We aimed to conduct a pilot study to measure IBA, with the Multidimensional Assessment of Interoceptive Awareness (MAIA), in patients seeking OMT for pain, and to test if OMT exposure may be associated with higher IBA as measured by the MAIA. The primary outcome was the change in MAIA scores, and the secondary outcomes were reduction in pain intensity, reduction in pain interference, and increase in participants' perception of change post-OMT. METHODS A convenience sample was recruited from individuals presenting for OMT appointments at a College of Osteopathic Medicine OMT teaching clinic. Participants were recruited into our single-arm observational cohort study (n=36), and categorized into one of two groups, OMT-naïve (n=19) or OMT-experienced (n=17), based on prior exposure to OMT. We measured MAIA scores and clinical pain-related outcomes prior to, immediately after, and at 1 and 3 weeks after a usual-care OMT session in the clinic. Covariates including experience with mind-body activities, non-OMT body work, and physical and emotional trauma were also collected to explore potential relationships. We utilized t tests to compare MAIA scores and pain outcomes between groups and across time points. Stepwise regression models were utilized to explore potential relationships with covariates. RESULTS The OMT-experienced group scored higher on the MAIA scales "Not-worrying" (p=0.002) and "Trusting" (p=0.028) at baseline. There were no significant changes in the MAIA scores before and after the single OMT session. Analysis of secondary outcomes revealed that all pain outcomes significantly decreased post-OMT (p<0.05), with the largest relative improvements in the acute pain and OMT-naïve subgroups, with diminishing effects over time. CONCLUSIONS Assessing IBA with MAIA in a clinical OMT setting is feasible. There were significant positive correlations between OMT exposure and two of the eight MAIA scales. Future studies are justified to further explore this relationship.
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Affiliation(s)
- Danielle K Emmet
- Department of Physical Medicine and Rehabilitation, New York Presbyterian 12295 , Weill Cornell Medicine and Columbia University , New York, USA
| | - Glenn Davis
- College of Osteopathic Medicine, 155229 Touro University California , Vallejo, CA, USA
| | - Stacey Pierce-Talsma
- College of Osteopathic Medicine, 115985 University of New England , Biddeford, ME, USA
| | - Jay H Shubrook
- College of Osteopathic Medicine, 155229 Touro University California , Vallejo, CA, USA
| | - Wolf Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, 8785 University California San Francisco , San Francisco, CA, USA
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Scheidegger A, Gómez Penedo JM, Blättler LT, Aybek S, Bischoff N, Grosse Holtforth M. How Treatment Motivation Predicts Favorable Outcomes in Interdisciplinary Multimodal Pain Treatment Among Patients with Chronic Primary Pain. J Clin Psychol Med Settings 2024; 31:48-57. [PMID: 37081250 PMCID: PMC10924698 DOI: 10.1007/s10880-023-09958-0] [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: 04/04/2023] [Indexed: 04/22/2023]
Abstract
As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively.
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Affiliation(s)
- Alina Scheidegger
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Psychology, University of Bern, Bern, Switzerland.
| | | | - Larissa Tatjana Blättler
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Selma Aybek
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nina Bischoff
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Grosse Holtforth
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
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Rodriguez A, Delbourgo Patton C, Stephenson-Hunter C. Impact of Locus of Control on Patient-Provider Communication: A Systematic Review. JOURNAL OF HEALTH COMMUNICATION 2023; 28:190-204. [PMID: 36974503 PMCID: PMC10227829 DOI: 10.1080/10810730.2023.2192014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Growing evidence shows there is heterogeneity in patient communication preferences and a need to tailor communication approaches accordingly. However, little is known about the psychosocial factors that influence communication preferences. Among them is locus of control (LOC), a belief about who or what determines outcomes, including health. Although LOC theory was developed over 60 years ago as a personality theory, its relevance in healthcare has increased over the past two decades. There is a paucity of empirical evidence on patient or provider LOC as it influences communication quality and outcomes in healthcare settings. We conducted a systematic review to collate the current state of the literature.We carried out a comprehensive search of PubMed MEDLINE, Embase, PsycInfo, and Cochrane Library databases to retrieve relevant peer-reviewed articles. A total of 1152 publications were identified. Our final review included 17 articles that underwent data extraction and quality assessment.The included studies found evidence of LOC associations with several patient and provider communication-related outcomes including satisfaction with care; medical decision-making and communication preferences; adherence; and patient-provider rapport. As opposed to generalized approaches to communication, assessing patient LOC may allow clinicians to tailor their approaches to match patients' LOC. Our findings provide a starting point and highlight the need for future studies.
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Affiliation(s)
- Alva Rodriguez
- CUNY School of Public Health & Health Policy, New York, NY, USA
| | | | - Cara Stephenson-Hunter
- Harold and Muriel Block Institute for Clinical and Translational Research, Department of Family and Social Medicine, The Albert Einstein College of Medicine, Bronx, New York, USA
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Lee J, Green BM, Palmarella G, McNamara K, Wachholtz A. Negative impact of chronic pain: The role of locus of control and perceived family validation of chronic pain. Health Psychol Open 2022; 9:20551029221125170. [PMID: 36091332 PMCID: PMC9449507 DOI: 10.1177/20551029221125170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study investigates how participants' locus of control and their family and friends' validation of their pain influences participants' chronic pain experiences. Four thousand, 25 adults were recruited through the Chronic Pain In America survey. Results show that individuals who endorse an internal locus of control and experience family and friends' validation of their chronic pain reported better chronic pain outcomes and less negative life impact due to chronic pain. The current results indicate the locus of control and family and friends' validation of chronic pain experience plays an important role in chronic pain and the impact of chronic pain across the life course.
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Affiliation(s)
- Jieun Lee
- Department of Psychology, Chung-Ang University, Seoul, South Korea
| | | | | | | | - Amy Wachholtz
- Department of Psychology, University of Colorado Denver, Denver, CO, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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Rees M, Kiemle G, Slade P. Psychological variables and quality of life in women with endometriosis. J Psychosom Obstet Gynaecol 2022; 43:58-65. [PMID: 32706632 DOI: 10.1080/0167482x.2020.1784874] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Endometriosis is a common gynecological condition which has been found to have a detrimental impact upon women's quality of life (QoL). This study investigated the impact of pain self-efficacy, health locus of control (HLOC), coping style and illness uncertainty on QoL in women with endometriosis. METHOD Two hundred and thirty women completed online questionnaires. Standard multiple regressions assessed the relationship between the psychological predictors and QoL. RESULTS The psychological variables accounted for a statistically significant proportion of the variance (p < .0005) in scores across the four QoL domains. The model accounted for 55, 26, 10 and 32% of the scores in physical, psychological, social and environmental QoL domains, respectively. Pain self-efficacy made the largest unique contribution, followed by illness uncertainty. CONCLUSIONS Women's perception of their ability to manage their pain and how uncertain they felt about their condition, were important factors in QoL, particularly in the physical domain.
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Affiliation(s)
- Madeleine Rees
- Clinical Health Psychology Service, Hywel Dda University Health Board, Carmarthen, UK
| | - Gundi Kiemle
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Pauline Slade
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Álvarez-Rodríguez J, Leirós-Rodríguez R, Morera-Balaguer J, Marqués-Sánchez P, Rodríguez-Nogueira Ó. The Influence of the Locus of Control Construct on the Efficacy of Physiotherapy Treatments in Patients with Chronic Pain: A Systematic Review. J Pers Med 2022; 12:jpm12020232. [PMID: 35207720 PMCID: PMC8880621 DOI: 10.3390/jpm12020232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 01/27/2023] Open
Abstract
The biopsychosocial paradigm contemplates the patient’s personality traits in physiotherapy treatments for chronic pain. Among these traits, the locus of control has a direct relationship with the person’s coping strategies in the face of their health problems. The objective of this systematic review was to assess the influence of locus of control on the efficacy of physiotherapy treatments in patients with chronic pain. A systematic review of the publications of the last ten years in Pubmed, Scopus, Science Direct and Web of Science databases was conducting with the terms physical therapy modalities, chronic pain, internal-external control, self-management, physical therapy and physiotherapy. The inclusion criteria were participants with chronic pain lasting at least three months who have received at least one session of physical therapy; the studies should have collected the patient’s locus of control as a prognostic factor at the beginning of physiotherapy treatment; the variables studied should include the pain intensity or clinical variables related to pain. A total of 13 articles were found, of which three were experimental studies and ten were observational studies. The included samples had chronic knee pain, nonspecific back pain, low back pain or neck pain; were people over 65 years of age or patients who had undergone hand surgery. In patients with chronic pain for more than three months, the locus of control construct participates as a predictor of the results of physiotherapy treatment. The presence of an internal locus of control favors better results. The personality traits of the subjects represent an important factor to take into account when planning physiotherapy treatments.
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Affiliation(s)
- Julia Álvarez-Rodríguez
- Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain;
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
- Correspondence:
| | - Jaume Morera-Balaguer
- Department of Physiotherapy, Health Science Faculty, CEU-Cardenal Herrera University, CEU Universities, 03204 Elche, Spain;
| | - Pilar Marqués-Sánchez
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
| | - Óscar Rodríguez-Nogueira
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
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Diener I. Physiotherapy support for self-management of persisting musculoskeletal pain disorders. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1564. [PMID: 34859158 PMCID: PMC8603210 DOI: 10.4102/sajp.v77i1.1564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Musculoskeletal pain (MSKP) is an extremely common pain disorder in almost all populations. Self-management (SM) support is a programme to prepare people to self-manage their health condition effectively, while maintaining quality of life. SM is a cost-effective and context-specific strategy to address the global public health burden. OBJECTIVES Self-management needs a change in behaviour from seeking unnecessary medical care to safely self-managing symptoms. As changing individuals' behaviour is challenging, the objective of my literature review was to identify the characteristics, in both therapist and patient, to successfully engage in SM. METHOD A narrative literature review, that could inform evidence-based support programmes for SM of MSKP. RESULTS Studies on successful implementation of SM of MSKP do not report strong outcomes. However, in more recent years a few positive outcomes were reported, possibly as a result of research evidence for the application of psychosocial skills and contemporary pain neuroscience in the management of persistent MSKP. CONCLUSION Psychologically-informed physiotherapy, addressing psychosocial barriers to the maintenance of SM programmes, could facilitate more successful outcomes. CLINICAL IMPLICATIONS Before engaging in a SM support programme, obstacles to behaviour change must be identified and addressed in a SM support programme, to facilitate individuals towards taking safe responsibility for their healthcare. Therapists working with patients with persistent MSKP, should upskill themselves to be in line with the latest pain and psychosocial research literature. Moreover, communication skills training seems to be a priority for effective SM support programmes.
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Affiliation(s)
- Ina Diener
- Department of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Bruehl S, Burns JW, Koltyn K, Gupta R, Buvanendran A, Edwards D, Chont M, Wu YH, Stone A. Does aerobic exercise training alter responses to opioid analgesics in individuals with chronic low back pain? A randomized controlled trial. Pain 2021; 162:2204-2213. [PMID: 33394881 PMCID: PMC8203753 DOI: 10.1097/j.pain.0000000000002165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT We tested whether aerobic exercise training altered morphine analgesic responses or reduced morphine dosages necessary for adequate analgesia. Patients with chronic back pain were randomized to an 18-session aerobic exercise intervention (n = 38) or usual activity control (n = 45). Before and after the intervention, participants underwent 3 laboratory sessions (double-blinded, crossover) to assess effects of saline placebo, i.v. morphine (0.09 mg/kg), and i.v. naloxone (12 mg) on low back pain and evoked heat pain responses. Differences in evoked and back pain measures between the placebo and morphine conditions indexed morphine analgesia, with pre-post intervention changes the primary outcome. Endogenous opioid analgesia was indexed by differences in evoked and low back pain measures between the naloxone and placebo conditions. A Sex X Intervention interaction on the analgesic effects of morphine on visual analogue scale back pain intensity was observed (P = 0.046), with a similar trend for evoked pain threshold (P = 0.093). Male exercisers showed reduced morphine analgesia pre-post intervention, whereas male controls showed increased analgesia (with no differences in females). Of clinical significance were findings that relative to the control group, aerobic exercise produced analgesia more similar to that observed after receiving ≈7 mg morphine preintervention (P < 0.045). Greater pre-post intervention increases in endogenous opioid function (from any source) were significantly associated with larger pre-post intervention decreases in morphine analgesia (P < 0.046). The overall pattern of findings suggests that regular aerobic exercise has limited direct effects on morphine responsiveness, reducing morphine analgesia in males only.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John W. Burns
- Department of Psychiatry, Rush University, Chicago, IL, USA
| | - Kelli Koltyn
- Department of Kinesiology, University of Wisconsin, Madison, WI, USA
| | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - David Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yung Hsuan Wu
- Department of Psychiatry, Rush University, Chicago, IL, USA
| | - Amanda Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Lewis GN, Bean DJ. What Influences Outcomes From Inpatient Multidisciplinary Pain Management Programs?: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:504-523. [PMID: 33883414 DOI: 10.1097/ajp.0000000000000941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although inpatient multidisciplinary pain management programs (PMPs) are effective for chronic pain, not all patients benefit equally and there is limited evidence regarding predictors of outcome. This meta-analysis aimed to identify patient or program characteristics associated with outcomes from inpatient PMPs, and to examine the time course of effects following discharge. MATERIALS AND METHODS Medline, EBSCO, and Scopus were searched to identify articles reporting outcomes from inpatient multidisciplinary PMPs. Information was extracted on study design, participant and program characteristics, and outcomes. Effect sizes were computed for pain, physical function, depression, anxiety, and mental health outcomes. Study-level predictors of outcome were investigated with moderator analyses and meta-regression. A risk of bias assessment and sensitivity analyses were conducted and the GRADE criteria for prognostic studies were applied to assess confidence in findings. RESULTS In all, 85 studies (111 cohorts; 15,255 participants) were included. Three quarters of studies demonstrated low risk of bias. Larger effect sizes (for at least 1 outcome measure) occurred in studies where participants had more severe pain (greater intensity/longer duration), participants with alcohol or drug problems were not excluded, samples comprised mixed pain conditions, and programs included a cognitive component and/or a passive therapy component. Effect sizes for pain and physical function were maintained at follow-up, but effect sizes for depression and anxiety declined over time. DISCUSSION Inpatient multidisciplinary PMPs may be well suited to patients with severe or long-lasting pain. Programs should adopt broad patient inclusion criteria, and outcomes were similar for programs based on cognitive-behavioral versus mindfulness/acceptance-based therapies.
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Affiliation(s)
- Gwyn N Lewis
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
| | - Debbie J Bean
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
- Chronic Pain Service, Department of Anaesthesiology & Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
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Pugliese M, Wolff A. The Value of Communication, Education, and Self-Management in Providing Guideline-Based Care: Lessons Learned from Musculoskeletal Telerehabilitation During the COVID-19 Crisis. HSS J 2020; 16:160-163. [PMID: 32837411 PMCID: PMC7397961 DOI: 10.1007/s11420-020-09784-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Matthew Pugliese
- Physical Therapy Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Aviva Wolff
- Hand Therapy Department, Hospital for Special Therapy, 535 East 70th Street, New York, NY 10021 USA
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