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Zhao X, Dannenberg K, Repsilber D, Gerdle B, Molander P, Hesser H. Prognostic subgroups of chronic pain patients using latent variable mixture modeling within a supervised machine learning framework. Sci Rep 2024; 14:12543. [PMID: 38822075 PMCID: PMC11143186 DOI: 10.1038/s41598-024-62542-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] [Received: 06/22/2023] [Accepted: 05/17/2024] [Indexed: 06/02/2024] Open
Abstract
The present study combined a supervised machine learning framework with an unsupervised method, finite mixture modeling, to identify prognostically meaningful subgroups of diverse chronic pain patients undergoing interdisciplinary treatment. Questionnaire data collected at pre-treatment and 1-year follow up from 11,995 patients from the Swedish Quality Registry for Pain Rehabilitation were used. Indicators measuring pain characteristics, psychological aspects, and social functioning and general health status were used to form subgroups, and pain interference at follow-up was used for the selection and the performance evaluation of models. A nested cross-validation procedure was used for determining the number of classes (inner cross-validation) and the prediction accuracy of the selected model among unseen cases (outer cross-validation). A four-class solution was identified as the optimal model. Identified subgroups were separable on indicators, predictive of long-term outcomes, and related to background characteristics. Results are discussed in relation to previous clustering attempts of patients with diverse chronic pain conditions. Our analytical approach, as the first to combine mixture modeling with supervised, targeted learning, provides a promising framework that can be further extended and optimized for improving accurate prognosis in pain treatment and identifying clinically meaningful subgroups among chronic pain patients.
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Affiliation(s)
- Xiang Zhao
- School of Behavioural, Social and Legal Sciences, Örebro University, Fakultetsgatan 1, 702 81, Örebro, Sweden
| | | | - Dirk Repsilber
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Björn Gerdle
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Peter Molander
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hugo Hesser
- School of Behavioural, Social and Legal Sciences, Örebro University, Fakultetsgatan 1, 702 81, Örebro, Sweden.
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
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Li A, Yang DD, Beauquesne A, Moro MR, Falissard B, Benoit L. Somatic symptoms in school refusal: a qualitative study among children, adolescents, and their parents during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02313-6. [PMID: 37821562 DOI: 10.1007/s00787-023-02313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
School refusal (SR) is commonly associated with somatic symptoms that are temporally related to school attendance. Abdominal pain, headache, vomiting, and musculoskeletal pain are frequently encountered and are usually not caused by a physical disease. School refusers, parents and health care workers are often puzzled by these impairing symptoms. In this qualitative study, we assessed somatic symptoms in a population encompassing both school refusers and their parents. We aimed at better understanding experiences and strategies in the management of these debilitating symptoms, while also investigating the journey of these symptoms and their behavioral consequences on the said population. We conducted qualitative interviews both within an Integrated Youth Health Care Unit in Paris and through a French parent-led support group improving care for school refusers. We interviewed 19 young persons with SR (aged 6-21 years old) and 20 parents. Using the Grounded Theory, three themes were identified: (1) somatic symptoms' journey in four phases (emergence, coping, crisis, and disappearance in the context of school dropout); (2) their deconstruction, indicating the patients' emotional state; and (3) their management through self-care practices as well as increased emotional and body awareness. Some parents, who could portray similar symptoms at a younger age, mentioned familial pattern of heightened emotional and sensorial sensitivity as a possible cause. Findings suggested that somatic symptoms in SR offer an insight into the patients' emotional state. We recommend that psychotherapies targeting somatic symptoms could be further assessed in SR, along with educational content aimed at increasing emotional literacy in schools and health care settings.
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Affiliation(s)
- Anne Li
- Maison de Solenn, Maison des Adolescents, AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, 75014, Paris, France.
- PCPP, Paris Cité University, 92100, Boulogne-Billancourt, France.
- CESP, UVSQ Inserm U1018, Paris-Saclay University, Villejuif, France.
- French Clinical Research Group in Adolescent Medicine and Health, Paris, France.
| | - David Dawei Yang
- Department of Pediatric Emergency, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Agathe Beauquesne
- Maison de Solenn, Maison des Adolescents, AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, 75014, Paris, France
- French Clinical Research Group in Adolescent Medicine and Health, Paris, France
- Sorbonne University, 75006, Paris, France
| | - Marie Rose Moro
- Maison de Solenn, Maison des Adolescents, AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, 75014, Paris, France
- PCPP, Paris Cité University, 92100, Boulogne-Billancourt, France
- CESP, UVSQ Inserm U1018, Paris-Saclay University, Villejuif, France
| | - Bruno Falissard
- CESP, UVSQ Inserm U1018, Paris-Saclay University, Villejuif, France
| | - Laelia Benoit
- Maison de Solenn, Maison des Adolescents, AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, 75014, Paris, France
- CESP, UVSQ Inserm U1018, Paris-Saclay University, Villejuif, France
- French Clinical Research Group in Adolescent Medicine and Health, Paris, France
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Carlson DM, Yarns BC. Managing medical and psychiatric multimorbidity in older patients. Ther Adv Psychopharmacol 2023; 13:20451253231195274. [PMID: 37663084 PMCID: PMC10469275 DOI: 10.1177/20451253231195274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity - the presence of two or more chronic conditions in an individual - which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors - including trauma and racism - that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.
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Affiliation(s)
- David M. Carlson
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Brandon C. Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg. 401, Rm. A236, Mail Code 116AE, Los Angeles, CA 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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4
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Körner AJ, Sabatowski R, Kaiser U. [Emotions in chronic pain : Changes in the course of day clinic interdisciplinary multimodal pain therapy]. Schmerz 2023:10.1007/s00482-023-00748-z. [PMID: 37644244 DOI: 10.1007/s00482-023-00748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023]
Abstract
RESEARCH QUESTION The present study examined the extent to which emotional experience and emotional competence (EC) change in people with chronic pain during interdisciplinary multimodal pain treatment (IMPT). METHODS The study included N = 184 adult German-speaking individuals with non-cancer-related chronic pain. They completed a day clinic IMPT. The frequency of specific emotions (anger, etc.) and EC was assessed at three measurement time points using the Questionnaire for Emotion-Specific Self-Assessment of Emotional Competencies (ERSQ-ES) and the Emotional Competency Questionnaire (ECQ). The course results were analyzed descriptively, inferentially, and using linear regression. RESULTS Positive emotions were experienced more frequently (effect size r = 0.40; p < 0.001) and negative emotions less frequently (r = 0.39, p < 0.001) at end of therapy. The experience of anger decreased particularly strongly (r = 0.52; p < 0.001). Self-assessed EC did not change during the IMPT (χ2ECQ_total (2) = 0.09; p = 0.956). EC largely explained the variance in the frequency experience of positive (R2 = 0.468) and negative emotions (R2 = 0.390). DISCUSSION Improvements in patient-reported frequencies of positive and negative emotions during IMPT were demonstrated. Further research should validate these results using a control group. Even though no explicit increase in competence was perceivable for the studied subjects, EC had a high predictive value for emotion frequency. Future therapy designs and evaluations should focus more on changes of emotional experience.
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Affiliation(s)
- Anne Juliane Körner
- UniversitätsSchmerzCentrum (USC), Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Rainer Sabatowski
- UniversitätsSchmerzCentrum (USC), Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Ulrike Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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Farooque M. Specific and Nonspecific Low Back Pain-Mind the Gap and its Impact in Clinical Practice: Opinion of a Recovering Interventional Spine Physiatrist. Spine J 2023:S1529-9430(23)00170-5. [PMID: 37116719 DOI: 10.1016/j.spinee.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Mustafa Farooque
- Department of Medicine at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Back & Spine Program at Aurora St. Luke's Medical Center, Milwaukee, WI, 2901 W Kinnickinnic River Pkwy, Suite 310, Milwaukee, WI.
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Aaron RV, McGill LS, Finan PH, Wegener ST, Campbell CM, Mun CJ. Determining Profiles of Pain-Specific and General Emotion Regulation Skills and Their Relation to 12-Month Outcomes Among People With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:667-678. [PMID: 36503109 PMCID: PMC10079591 DOI: 10.1016/j.jpain.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Difficulties with pain-specific emotion regulation (ER; eg, pain catastrophizing, pain acceptance) are associated with poor pain outcomes. Less is known about how general ER relates to pain outcomes, or the extent to which pain-specific and general ER interact. In a sample (N = 1,453) of adults with chronic pain, the current study used latent profile analysis to identify subgroups of people with distinct pain-specific and general ER profiles, and determined how subgroup membership at baseline related to pain severity, pain interference, depression and anxiety symptoms at 12-month follow-up. Four groups were identified: 1) general ER difficulties only (29.6%); 2) pain-specific and general ER difficulties (26.3%); 3) skillful pain-specific and general ER (24.6%); 4) pain-specific ER difficulties only (19.4%). Controlling for auto-correlation and demographic covariates, those with pain-specific and general ER difficulties had the worst outcomes in all domains. Membership to other groups did not differentiate between pain severity or interference outcomes; those skillful in pain-specific and general ER had the lowest depression and anxiety symptoms at 12 months. General ER difficulties are common among adults with chronic pain and raise relative risk when paired with pain-specific ER difficulties. Findings offer potential directions for individualizing pain psychology treatment. PERSPECTIVE: This article shows that people with chronic pain have different sets of strengths and difficulties when it comes to regulating emotions related and/or unrelated to the experience of pain itself. Understanding an individual's unique constellation of emotion regulation skills and difficulties might help personalize the psychological treatment of pain.
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Affiliation(s)
- Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Edson College of Nursing and Health Innovation, Arizona State University, Pheonix, Arizona
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7
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Understanding Nociplastic Pain: Building a Bridge between Clinical Psychology and Medicine. J Pers Med 2023; 13:jpm13020310. [PMID: 36836544 PMCID: PMC9968114 DOI: 10.3390/jpm13020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Chronic pain (CP), defined as pain lasting more than three months, is a significant healthcare challenge with considerable economic costs [...].
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8
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Yarns BC, Zhu TA, Najafian Jazi A. Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach. Am J Geriatr Psychiatry 2022; 30:1342-1350. [PMID: 35999127 DOI: 10.1016/j.jagp.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Chronic pain remains a serious healthcare challenge, particularly for older adults who suffer substantial disability and are susceptible to serious risks from pain medications and invasive procedures. Psychotherapy is a promising option for older adults with chronic pain, since it does not contribute to medical or surgical risks. However, standard psychotherapies for chronic pain, including cognitive-behavioral therapy (CBT), acceptance and commitment therapy, and mindfulness-based interventions, produce only modest and time-limited benefits for older adults. In this article, we describe a novel, evidence-based psychological assessment and treatment approach for older adults with chronic pain, including a detailed case example. The approach begins with reviewing patients' pain, psychosocial, and medical histories to elicit evidence of a subtype of chronic pain called centralized (primary, nociplastic, or psychophysiologic) pain, which is highly influenced and may even be caused by life stress, emotions, and alterations in brain function. Patients then undertake a novel psychotherapy approach called emotional awareness and expression therapy (EAET) that aims to reduce or eliminate centralized pain by resolving trauma and emotional conflicts and learning healthy communication of adaptive emotions. Our published preliminary clinical trial (n = 53) indicated that EAET produced statistically significant and large effect size advantages over CBT in pain reduction and marginally greater improvements in pain interference than CBT for older adults with chronic musculoskeletal pain. Geriatric mental healthcare providers may learn this assessment and treatment approach to benefit many of their patients with chronic pain.
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Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA.
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health (BCY,TAZ,ANJ), VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (BCY,TAZ,ANJ), University of California, Los Angeles (UCLA), Los Angeles, CA
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9
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Morie KP, Crowley MJ, Mayes LC, Potenza MN. The process of emotion identification: Considerations for psychiatric disorders. J Psychiatr Res 2022; 148:264-274. [PMID: 35151218 PMCID: PMC8969204 DOI: 10.1016/j.jpsychires.2022.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Abstract
Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions. Here, we propose a model of seven components that may provide a foundation for emotion identification. These factors include baseline mood, monitoring, physiological responses, interoception, past personal experiences regarding emotions/metacognition, context, and labeling. We additionally examine how deficits in different components may contribute to the concept of alexithymia, which is defined by difficulty identifying and describing one's own emotions. Ultimately, we explore how the model may support a relationship between specific psychiatric disorders and alexithymia. The proposed model may help explain emotional identification impairment in multiple psychiatric disorders and guide future research and treatment development efforts.
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Affiliation(s)
- Kristen P Morie
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA.
| | - Michael J Crowley
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Linda C Mayes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA; Connecticut Mental Health Center, New Haven, CT, 06519, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, 06510, USA
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10
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Ahlquist LR, Yarns BC. Eliciting emotional expressions in psychodynamic psychotherapies using telehealth: a clinical review and single case study using emotional awareness and expression therapy. PSYCHOANALYTIC PSYCHOTHERAPY 2022; 36:124-140. [PMID: 36711048 PMCID: PMC9881109 DOI: 10.1080/02668734.2022.2037691] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The COVID-19 pandemic and ensuing social distancing requirements resulted in an abrupt transition in the provision of most mental healthcare to telehealth; yet it was, at first, unclear whether patients' emotional expressions - of great import to the success of many psychodynamic therapies - could be facilitated using teletherapy. This article first presents a targeted literature review focused on emotional expressions in psychotherapy and implementing psychodynamic therapy over telehealth and then describes our clinical experience transitioning a psychodynamically-informed, evidence-based, and experiential group treatment for chronic pain, emotional awareness and expression therapy (EAET), to video telehealth at VA Greater Los Angeles Healthcare System. We discuss barriers we encountered in our implementation of EAET over video telehealth but also illustrate the ultimate success of the approach using verbatim excerpts from our therapeutic work, which aim to demonstrate the potential to facilitate powerful emotional expressions over video telehealth when conducting a psychodynamically-informed treatment. We examine the possible applications for video telehealth to maintain emotionally focused, psychodynamic psychotherapy administration and enhance its teaching and training. Although we describe limitations of our specific approach, ultimately, our experience supports the potential efficacy of experiential, emotion-focused psychodynamic therapies in a telehealth setting.
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Affiliation(s)
- Lauren R. Ahlquist
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Brandon C. Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,Corresponding author. 11301 Wilshire Blvd, Mail Code 116AE, Bldg. 401, Rm. A236, Los Angeles, CA 90073, USA
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11
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At the Intersection of Anger, Chronic Pain, and the Brain: A Mini-Review. Neurosci Biobehav Rev 2022; 135:104558. [PMID: 35122780 DOI: 10.1016/j.neubiorev.2022.104558] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 01/30/2023]
Abstract
Chronic pain remains one of the most persistent healthcare challenges in the world. To advance pain treatment, experts have recently introduced research-driven subtypes of chronic pain based on proposed underlying mechanisms. Nociplastic pain (e.g., nonspecific chronic low back or fibromyalgia) is one such subtype which may involve a greater etiologic role for brain plasticity, painful emotions induced by life stress and trauma, and unhealthy emotion regulation. In particular, correlational and behavioral data link anger and the ways anger is regulated with the presence and severity of nociplastic pain. Functional neuroimaging studies also suggest nociplastic pain and healthy anger regulation demonstrate inverse patterns of activity in the medial prefrontal cortex and amygdala; thus, improving anger regulation could normalize activity in these regions. In this Mini-Review, we summarize these findings and propose a unified, biobehavioral model called the Anger, Brain, and Nociplastic Pain (AB-NP) Model, which can be tested in future research and may advance pain care by informing new treatments that address anger, anger regulation, and brain plasticity for nociplastic pain.
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12
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1515-1526. [DOI: 10.1093/arclin/acac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/12/2022] Open
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