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Lappalainen P, Keinonen K, Lappalainen R, Selinheimo S, Vuokko A, Sainio M, Liesto S, Tolvanen A, Paunio T. Online acceptance and commitment therapy (iACT) for adults with persistent physical symptoms - 3-month follow-up study of a randomized controlled trial. J Psychosom Res 2024; 183:111830. [PMID: 38878337 DOI: 10.1016/j.jpsychores.2024.111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Persistent physical symptoms (PPS) represent a major health problem affecting daily functioning. This RCT aimed to examine whether a guided Internet-based treatment based on acceptance and commitment therapy (ACT) provided additional benefits compared to Treatment as Usual (TAU) in reducing somatic complaints and psychological distress in adults with PPS. METHODS A total of 103 adults with PPS related to indoor environments, chronic fatigue or both conditions were assigned to receive either either a 14-week intervention (video-based case conceptualization + Internet-based ACT) combined with TAU (iACT + TAU; n = 50) or TAU alone (n = 53). Somatic symptoms, depression, anxiety, insomnia, and psychological flexibility were assessed from pre-intervention to a 3-month follow-up. Additionally, the association between changes in psychological flexibility from pre- to post-intervention and changes in symptoms from pre to 3-month follow-up was explored. Analyses were conducted using a multigroup method with full information maximum likelihood estimator. RESULTS The results revealed a significant interaction effect, indicating reductions in somatic symptoms and symptoms of depression and anxiety with moderate to large between-group effects (d = 0.71-1.09). No significant interaction effect was observed in insomnia and measures of psychological flexibility. CONCLUSION Internet-based ACT, when combined with Treatment as Usual, demonstrated efficacy for individuals with PPS associated with indoor environments and chronic fatigue. These findings are pertinent for primary healthcare providers, suggesting that the current treatment model could serve as a low-threshold first-line treatment option. THE CLINICAL TRIAL REGISTRATION NUMBER NCT04532827.
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Affiliation(s)
| | | | | | | | - Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Markku Sainio
- Outpatient Clinic for Persistent Symptom Rehabilitation, HUS Helsinki University Hospital, Helsinki, Finland
| | - Sanna Liesto
- Outpatient Clinic for Persistent Symptom Rehabilitation, HUS Helsinki University Hospital, Helsinki, Finland
| | - Asko Tolvanen
- Department of Psychology, University of Jyväskylä, Finland
| | - Tiina Paunio
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Psychiatry and SleepWell Research Programme, Faculty of Medicine University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Mountford R, Adler BL, Andersson D, Bashford-Rogers R, Berwick R, Bevan S, Caro X, Chung TH, Clark JD, Dawes JM, Dong X, Helyes Z, Kingery W, van Middendorp JJ, Neiland H, Maurer M, Scheibenbogen C, Schmack K, Schreiner T, Svensson CI, Tékus V, Goebel A. Antibody-mediated autoimmunity in symptom-based disorders: position statement and proceedings from an international workshop. Pain Rep 2024; 9:e1167. [PMID: 38873615 PMCID: PMC11175924 DOI: 10.1097/pr9.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 06/15/2024] Open
Abstract
A 2-day closed workshop was held in Liverpool, United Kingdom, to discuss the results of research concerning symptom-based disorders (SBDs) caused by autoantibodies, share technical knowledge, and consider future plans. Twenty-two speakers and 14 additional participants attended. This workshop set out to consolidate knowledge about the contribution of autoantibodies to SBDs. Persuasive evidence for a causative role of autoantibodies in disease often derives from experimental "passive transfer" approaches, as first established in neurological research. Here, serum immunoglobulin (IgM or IgG) is purified from donated blood and transferred to rodents, either systemically or intrathecally. Rodents are then assessed for the expression of phenotypes resembling the human condition; successful phenotype transfer is considered supportive of or proof for autoimmune pathology. Workshop participants discussed passive transfer models and wider evidence for autoantibody contribution to a range of SBDs. Clinical trials testing autoantibody reduction were presented. Cornerstones of both experimental approaches and clinical trial parameters in this field were distilled and presented in this article. Mounting evidence suggests that immunoglobulin transfer from patient donors often induces the respective SBD phenotype in rodents. Understanding antibody binding epitopes and downstream mechanisms will require substantial research efforts, but treatments to reduce antibody titres can already now be evaluated.
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Affiliation(s)
- Rebecca Mountford
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Brittany L. Adler
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - David Andersson
- Wolfson SPaRC, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Richard Berwick
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
- Wolfson SPaRC, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Stuart Bevan
- Wolfson SPaRC, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Xavier Caro
- Southern California Fibromyalgia Research & Treatment Centre, Northridge Hospital Medical Center Professional Building, Los Angeles, CA, USA
| | - Tae Hwan Chung
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Neurology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - J. David Clark
- Department of Anesthesia, Stanford University School of Medicine, Redwood City, CA, USA
| | - John M. Dawes
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Xinzhong Dong
- Solomon H. Snyder Department of Neuroscience, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medial School, University of Pécs, Pécs, Hungary
- HUNREN-PTE Chronic Pain Research Group, University of Pécs, Pécs, Hungary
- PharmInVivo Ltd., Pécs, Hungary
| | - Wade Kingery
- Palo Alto Veterans Institute for Research, Palo Alto, CA, USA
| | | | - Harvey Neiland
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Margot Maurer
- Wolfson SPaRC, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katharina Schmack
- Francis Crick Institute, London, United Kingdom
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Camilla I. Svensson
- Department of Physiology and Pharmacology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Valéria Tékus
- Department of Pharmacology and Pharmacotherapy, Medial School, University of Pécs, Pécs, Hungary
- Department of Laboratory Diagnostics, University of Pécs, Pécs, Hungary
| | - Andreas Goebel
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
- Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Richards T. Not "all in the mind". BMJ 2024; 385:q1210. [PMID: 38849133 DOI: 10.1136/bmj.q1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
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Röhricht F, Green C, Filippidou M, Lowe S, Power N, Rassool S, Rothman K, Shah M, Papadopoulos N. Integrated care model for patients with functional somatic symptom disorder - a co-produced stakeholder exploration with recommendations for best practice. BMC Health Serv Res 2024; 24:698. [PMID: 38831287 PMCID: PMC11145802 DOI: 10.1186/s12913-024-11130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals' understanding of the nature of the symptoms. New service models are urgently needed to address patients' needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body-mind dichotomy. METHOD A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice. RESULTS The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment. CONCLUSION We propose a novel, integrated care pathway for patients with 'functional somatic disorder', which delivers care according to and working with patients' explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient's complaints and provide flexible access points to the care pathway.
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Affiliation(s)
- Frank Röhricht
- East London NHS Foundation Trust (ELFT), London, United Kingdom.
- Queen Mary University of London, London, United Kingdom.
| | - Carole Green
- Bedfordshire Community Health Services (BCHS), Bedford, United Kingdom
| | - Maria Filippidou
- Bedford Liaison Psychiatry Service, ELFT, Bedford, United Kingdom
| | - Simon Lowe
- Circle Bedfordshire Integrated Care Musculoskeletal Service, Bedford, United Kingdom
| | - Nicki Power
- East London NHS Foundation Trust (ELFT), London, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - Sara Rassool
- Clinical Health Psychology Services Bedfordshire & Luton, ELFT, Dunstable, United Kingdom
| | - Katherine Rothman
- Bedfordshire & Luton Community Adult Mental Health & Learning Disability Services , ELFT, Clapham, United Kingdom
| | - Meera Shah
- Clinical Health Psychology Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Thursby S, Dismore L, Swainston K. Clinical skills development for healthcare practitioners working with patients with persistent physical symptoms (PPS) in healthcare settings: a systematic review and narrative synthesis. BMC MEDICAL EDUCATION 2024; 24:328. [PMID: 38519955 PMCID: PMC10960475 DOI: 10.1186/s12909-024-05306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The complexity and uncertainty around Persistent Physical Symptoms (PPS) make it difficult to diagnose and treat, particularly under time-constrained consultations and limited knowledge. Brief interventions that can be utilised in day-to-day practice are necessary to improve ways of managing PPS. This review aimed to establish (i) what training primary and secondary healthcare practitioners have undertaken to develop their clinical skills when working with PPS, (ii) what training techniques or theoretical models have been used within these interventions, and (iii) how effective was the training. METHOD A systematic literature search was undertaken on eight databases to identify professional development interventions for healthcare practitioners working with PPS, were of any study design, and at a minimum were single measure studies (i.e., training outcome alone). Studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and narratively synthesised. RESULTS Despite high methodological heterogeneity across the six included studies, they all aimed to improve healthcare practitioners' communication skills through educational (theory, awareness, attitudes, assessment, treatment, and management of PPS) and experiential (role play) learning. CONCLUSIONS The review findings demonstrate that developing healthcare practitioners' communicative behaviours led to increased confidence and self-efficacy when working with PPS, which facilitated improved consultations and improvements on some patient outcomes. Barriers to the uptake of training programmes and implementation into daily clinical practice are discussed, including the need for PPS to be formally implemented into undergraduate teaching and post-qualification continuous professional development. TRIAL REGISTRATION This review was registered at PROSPERO [CRD42022315631] prior to the review starting.
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Affiliation(s)
- Stacie Thursby
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, NE29 8NH, United Kingdom
| | - Lorelle Dismore
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, NE29 8NH, United Kingdom
| | - Katherine Swainston
- Faculty of Medical Sciences, School of Psychology, Newcastle University, 4 Floor Dame Margaret Barbour Building, Wallace Street, Newcastle Upon Tyne, NE1 7RU, England.
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Chaturvedi J, Wang T, Velupillai S, Stewart R, Roberts A. Development of a Knowledge Graph Embeddings Model for Pain. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:299-308. [PMID: 38222382 PMCID: PMC10785867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Pain is a complex concept that can interconnect with other concepts such as a disorder that might cause pain, a medication that might relieve pain, and so on. To fully understand the context of pain experienced by either an individual or across a population, we may need to examine all concepts related to pain and the relationships between them. This is especially useful when modeling pain that has been recorded in electronic health records. Knowledge graphs represent concepts and their relations by an interlinked network, enabling semantic and context-based reasoning in a computationally tractable form. These graphs can, however, be too large for efficient computation. Knowledge graph embeddings help to resolve this by representing the graphs in a low-dimensional vector space. These embeddings can then be used in various downstream tasks such as classification and link prediction. The various relations associated with pain which are required to construct such a knowledge graph can be obtained from external medical knowledge bases such as SNOMED CT, a hierarchical systematic nomenclature of medical terms. A knowledge graph built in this way could be further enriched with real-world examples of pain and its relations extracted from electronic health records. This paper describes the construction of such knowledge graph embedding models of pain concepts, extracted from the unstructured text of mental health electronic health records, combined with external knowledge created from relations described in SNOMED CT, and their evaluation on a subject-object link prediction task. The performance of the models was compared with other baseline models.
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Affiliation(s)
- Jaya Chaturvedi
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Tao Wang
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Sumithra Velupillai
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Angus Roberts
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Masood R, Mandalia K, Pagani NR, Moverman MA, Puzzitiello RN, Menendez ME, Salzler MJ. Functional somatic syndromes are associated with inferior outcomes and increased complications after hip and knee arthroplasty: a systematic review. ARTHROPLASTY 2024; 6:2. [PMID: 38173047 PMCID: PMC10765755 DOI: 10.1186/s42836-023-00223-1] [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: 05/22/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Functional somatic syndromes (FSSs), defined as chronic physical symptoms with no identifiable organic cause, may impact results after hip and knee arthroplasty. The purpose of this study was to perform a systematic review assessing the relationship between FSSs and clinical outcomes after primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA). METHODS The PubMed and Web of Science databases were queried from January 1955 through December 2021 for studies investigating the impact of at least one FSS (fibromyalgia, irritable bowel syndrome (IBS), chronic headaches, and chronic low back pain) on outcomes after primary THA/TKA/UKA. Outcomes of interest included patient-reported outcome measures (PROMs), postoperative opioid use, complications, revisions, and costs of care. RESULTS There were twenty-eight studies, including 768,909 patients, of which 378,384 had an FSS. Five studies reported preoperative PROMs prior to THA/TKA, all of which showed worse PROMs among patients with at least 1 FSS diagnosis. Thirteen studies reported postoperative PROMs after THA/TKA, all of which demonstrated worse PROMs among patients with at least 1 FSS diagnosis. Patients with FSS diagnoses were more likely to continue using opioids at 3, 6, and 12 months following TKA, THA, and UKA. Medical and surgical complications, as well as revision rates, were higher among patients with FSSs. CONCLUSION Patients with FSSs have inferior PROMs and are at increased risk for prolonged postoperative opioid use, medical and surgical complications, and revision after hip and knee arthroplasty. Improved understanding of the factors influencing the success of hip and knee arthroplasty is critical. Future studies should address the biopsychosocial determinants of health that can impact outcomes after total joint arthroplasty.
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Affiliation(s)
- Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, Biewand Building, 7th Floor, 800 Washington St., Box 306, Boston, MA, 02111, USA
| | | | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Biewand Building, 7th Floor, 800 Washington St., Box 306, Boston, MA, 02111, USA
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Biewand Building, 7th Floor, 800 Washington St., Box 306, Boston, MA, 02111, USA
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Biewand Building, 7th Floor, 800 Washington St., Box 306, Boston, MA, 02111, USA
| | | | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Biewand Building, 7th Floor, 800 Washington St., Box 306, Boston, MA, 02111, USA.
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Cunningham R, Imlach F, Haitana T, Every-Palmer S, Lacey C, Lockett H, Peterson D. It's not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare. Front Psychiatry 2023; 14:1285431. [PMID: 37908598 PMCID: PMC10613695 DOI: 10.3389/fpsyt.2023.1285431] [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: 08/30/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Clinician bias contributes to lower quality healthcare and poorer health outcomes in people with mental health and substance use conditions (MHSUC). Discrimination can lead to physical conditions being overlooked (diagnostic overshadowing) or substandard treatment being offered to people with MHSUC. This research aimed to utilise experiences of people with MHSUC to identify discrimination by clinicians, including the role of clinician's beliefs and assumptions in physical health service provision. Methods We surveyed people with MHSUC who accessed physical healthcare services. Of 354 eligible participants, 253 responded to open-ended questions about experiences of those services. Thematic descriptive analysis of survey responses was completed using existing stigma frameworks and inductive coding. Results One dominant theme from survey responses was that diagnostic overshadowing by clinicians was driven by clinician mistrust. Another theme was that clinicians assumed respondent's physical symptoms, including pain, were caused by MHSUC. This influenced decisions not to initiate investigations or treatment. Respondents perceived that clinicians focused on mental health over physical health, contributing to suboptimal care. Discussion Discrimination based on MHSUC leads to poor quality care. Health systems and clinicians need to focus quality improvement processes on access to and delivery of equitable physical healthcare to people with MHSUC, address stereotypes about people with MHSUC and improve integration of mental and physical healthcare.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Fiona Imlach
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Tracy Haitana
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Helen Lockett
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Teodoro T, Oliveira R. The conceptual field of medically unexplained symptoms and persistent somatic symptoms. CNS Spectr 2023; 28:526-527. [PMID: 36321347 DOI: 10.1017/s1092852922001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tomás Teodoro
- Early Intervention & First Episode Psychosis Unit, Department of Psychiatry, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
- Adult ADHD & Neurodevelopmental Disorders Outpatient Service, Department of Psychiatry, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
- Emergency Psychiatry Unit, Department of Emergency Medicine, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, NOVA University Lisbon, Lisbon, Portugal
| | - Renato Oliveira
- Comprehensive Health Research Centre, NOVA Medical School, NOVA University Lisbon, Lisbon, Portugal
- Department of Neurology & Headache Centre, Hospital da Luz-Lisboa, Lisbon, Portugal
- Department of Mental Health and Neurosciences, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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Butt MF, Visaggi P, Singh R, Vork L. Lack of awareness of neurogastroenterology and motility within medical education: Time to fill the gap. Neurogastroenterol Motil 2023; 35:e14666. [PMID: 37660362 DOI: 10.1111/nmo.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
Disorders of gut-brain interaction (DGBI), previously referred to as functional gastrointestinal disorders, affect 40.3% of adults in the general population and are diagnosed in 34.9% of new adult referrals to secondary care gastroenterology services. Despite their high prevalence, studies published in this issue of Neurogastroenterology and Motility by investigators based in Germany, the UK, and the USA demonstrate a mismatch between the clinical burden of DGBI and their representation in medical school and postgraduate curricula. This review outlines the salient findings of these studies and explores why and how negative perceptions toward DGBI exist, including factors related to misinformation and internalized stigma. The authors propose a selection of strategies to ameliorate physicians' attitudes toward and knowledge of neurogastroenterology and motility including linking trainees with dedicated clinician mentors with an interest in motility, exposing trainees to expert patients who can enhance empathy, extending Balint groups into gastroenterology training, and offering motility apprenticeships in specialist units. Urgent improvements to medical school and postgraduate curricula are required to ensure the longevity of this subspecialty field in gastroenterology, and to ensure the needs of a sizeable proportion of gastroenterology patients are appropriately met.
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Affiliation(s)
- Mohsin F Butt
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Centre for Neuroscience, Trauma and Surgery, Wingate Institute of Neurogastroenterology, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rajan Singh
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Lisa Vork
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastrict, The Netherlands
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11
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Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med 2023; 11:20503121231194400. [PMID: 37655303 PMCID: PMC10467233 DOI: 10.1177/20503121231194400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - April Elliott
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Muacevic A, Adler JR. Understanding Patient-Provider Interaction, Treatment Acceptance, and Outcomes in Medically Unexplained Symptoms. Cureus 2022; 14:e32915. [PMID: 36699771 PMCID: PMC9871694 DOI: 10.7759/cureus.32915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Medically unexplained symptoms (MUS) is an umbrella term used for chronic and often disabling health symptoms and conditions that remain unexplained after standard medical examinations, testing, and/or appropriate workup. Patients with MUS tend to receive little to no treatment but remain distressed, stigmatized, and disabled by symptoms and iatrogenic factors. METHODS A qualitative phenomenological study was conducted to explore daily challenges and psychosocial and iatrogenic factors affecting the management of MUS. RESULTS The analysis of the interviews revealed that MUS could cause significant distress to patients, impairing their functioning and leading to permanent disability. Conventional healthcare cannot meet the medical needs of these patients and might be a potential source of harm to them. It should be noted that confirmation of conditions associated with clinically significant psychiatric premorbidity was not provided. CONCLUSION Inconsistent diagnostic criteria, lack of proper training and research, diagnostic overshadowing, and implicit bias in healthcare professionals can lead to negative patient outcomes and the overuse of alternative or non-evidence-based services. Guidance, practice-based improvement ideas, and suggestions specific to improving patient-provider relationships can be applied to generate positive health effects.
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13
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McLeod J, Sundet R. Psychotherapy as making. Front Psychol 2022; 13:1048665. [DOI: 10.3389/fpsyg.2022.1048665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Historically, research and practice of psychotherapy have been conducted within conceptual frameworks defined in terms of theoretical models. These models are in turn guided by meta-theories about the purpose of psychotherapy and its place in society. An image of psychotherapy that underpins much contemporary practice is the idea that therapy operates as an intervention that involves the implementation and application of a pre-existing theoretical model or set of empirically validated procedures. The present paper introduces the idea that it may be valuable to regard psychotherapy not as an intervention but instead as a process of making, in the sense of offering a cultural space for the co-construction of meaningful and satisfying ways of living that draw on shared cultural resources. We offer an overview of what a therapy of making might look like, followed by an account of theoretical perspectives, both within the psychotherapy literature and derived from wider philosophical and social science sources, that we have found valuable in terms of making sense of this way of thinking about practice. Our conclusion is that we need something in addition to theory-specific and protocol-driven therapies, in order to be able to incorporate the unexpected, the not-before-met perspective, event or practice of living, and to be open towards the radically new, the given, and the unknown.
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Wilson N, Beasley MJ, Pope C, Dulake D, Moir LJ, Hollick RJ, Macfarlane GJ. UK healthcare services for people with fibromyalgia: results from two web-based national surveys (the PACFiND study). BMC Health Serv Res 2022; 22:989. [PMID: 35922796 PMCID: PMC9347075 DOI: 10.1186/s12913-022-08324-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background The UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes. Aim To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia. Methods Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data. Results Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK. Conclusion This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08324-4.
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Affiliation(s)
- Nicky Wilson
- Departments of Rheumatology and Therapies, King's College Hospital NHS Foundation Trust, London, UK.
| | - Marcus J Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Laura J Moir
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
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Yagi T, Sawada K, Miyamoto M, Kinose Y, Nakagawa S, Takiuchi T, Kodama M, Kobayashi E, Hashimoto K, Mabuchi S, Tomimatsu T, Yoshino K, Kimura T. Safety and efficacy of Ninjin'yoeito along with iron supplementation therapy for preoperative anemia, fatigue, and anxiety in patients with gynecological disease: an open-label, single-center, randomized phase-II trial. BMC Womens Health 2022; 22:229. [PMID: 35701778 PMCID: PMC9195328 DOI: 10.1186/s12905-022-01824-9] [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] [Received: 10/28/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Preoperative anemia affects perioperative outcomes and often causes fatigue and psychological disorders. Therefore, anemia should be treated before a patient undergoes surgery. Ninjin’yoeito (NYT), a Japanese Kampo medicine composed of ginseng and Japanese angelica root with the other 10 herbs, is administered for anemia, fatigue and anxiety; however, there are a few reports that have prospectively examined the effects of NYT before surgery for gynecological diseases. Hence, we tended to investigate its efficacy and safety. Methods In this open-label randomized trial, women with gynecological diseases accompanied by preoperative anemia (defined as < 11.0 g/dL Hemoglobin [Hb]) were randomly assigned (1:1) into the iron supplementation and NYT groups. Patients of the iron supplementation group and the NYT group received 100 mg/day iron supplementation with and without NYT (7.5 g/day) for at least 10 days before surgery. The primary endpoint was improvement in Hb levels before and after treatment, and Cancer Fatigue Scale (CFS) and Visual Analogue Scale for Anxiety (VAS-A) scores between groups. Statistical analyses were performed with Wilcoxon signed rank test, Wilcoxon rank sum test, and Fisher’s exact test as appropriate. Results Forty patients were enrolled of whom 30 patients were finally analyzed after allocating 15 to each group. There was no difference in the characteristics between both groups. Hb significantly increased in both groups (iron supplementation group, 9.9 ± 0.8 g/dL vs. 11.9 ± 1.6 g/dL; NYT group, 9.8 ± 1.0 g/dL vs. 12.0 ± 1.0 g/dL); the difference in the elevations in Hb between both groups was statistically insignificant (P = 0.72). Contrarily, CFS (17.9 ± 10.2 vs. 8.1 ± 5.2) and VAS-A (56 mm (50–70) vs. 23 mm (6–48)) scores were significantly decreased only in the NYT group and these changes were greater in the NYT group (∆CFS, P = 0.015; ∆VAS-A, P = 0.014). Liver dysfunction occurred in one patient of the NYT group. Conclusions For treating preoperative anemia in women with gynecological conditions, NYT administration along with iron supplementation safely and efficiently improved the preoperative fatigue and anxiety in addition to the recovery from anemia. Trial registration: jRCT1051190012 (28/April/2019, retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01824-9.
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Affiliation(s)
- Taro Yagi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Kenjiro Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan.
| | - Mayuko Miyamoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Yasuto Kinose
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Satoshi Nakagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan.,Department of Clinical Genomics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Michiko Kodama
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Kae Hashimoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan.,Department of Genetic Counseling, Osaka University Hospital, Osaka, Japan
| | - Seiji Mabuchi
- Department of Gynecologic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, Japan
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Maxwell E. Evidence-based nursing in times of uncertainty. Evid Based Nurs 2022; 25:ebnurs-2022-103569. [PMID: 35649709 DOI: 10.1136/ebnurs-2022-103569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Elaine Maxwell
- Institute of Health and Social Care, London South Bank University, London, UK
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Huang Y, Xu J, Liu Q, Zeng Z, Zhang Y. Stellate ganglion block successfully relieved medically unexplained chronic pain: a case report. J Int Med Res 2022; 50:3000605221086735. [PMID: 35301893 PMCID: PMC8935417 DOI: 10.1177/03000605221086735] [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: 11/28/2022] Open
Abstract
Medically unexplained symptoms refers to a clinical syndrome characterized by somatic symptoms that cannot be reasonably explained by any organic disease. Chronic pain can be a type of medically unexplained symptom. The current treatment modalities for chronic pain mainly include drugs and psychotherapy. The use of stellate ganglion block for treatment of chronic pain has rarely been reported. Herein, we report a patient whose chronic pain was completely relieved after receiving a stellate ganglion block.
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Affiliation(s)
- Yiting Huang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Jian Xu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Qingyan Liu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Zhimin Zeng
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
| | - Yuenong Zhang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Guangdong, China
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Enhanced Ocular Surface and Intraoral Nociception via a Transient Receptor Potential Vanilloid 1 Mechanism in a Rat Model of Obstructive Sleep Apnea. Neuroscience 2021; 483:66-81. [PMID: 34883200 DOI: 10.1016/j.neuroscience.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022]
Abstract
Obstructive sleep apnea (OSA), characterized by low arterial oxygen saturation during sleep, is associated with an increased risk of orofacial pain. In this study, we simulated chronic intermittent hypoxia (CIH) during the sleep/rest phase (light phase) to determine the role of transient receptor potential vanilloid 1 (TRPV1) in mediating enhanced orofacial nocifensive behavior and trigeminal spinal subnucleus caudalis (Vc) neuronal responses to capsaicin (a TRPV1 agonist) stimulation in a rat model of OSA. Rats were subjected to CIH (nadir O2, 5%) during the light phase for 8 or 16 consecutive days. CIH yielded enhanced behavioral responses to capsaicin after application to the ocular surface and intraoral mucosa, which was reversed under normoxic conditions. The percentage of TRPV1-immunoreactive trigeminal ganglion neurons was greater in CIH rats than in normoxic rats and recovered under normoxic conditions after CIH. The ratio of large-sized TRPV1-immunoreactive trigeminal ganglion neurons increased in CIH rats. The density of TRPV1 positive primary afferent terminals in the superficial laminae of Vc was higher in CIH rats. Phosphorylated extracellular signal-regulated kinase (pERK)-immunoreactive cells intermingled with the central terminal of TRPV1-positive afferents in the Vc. The number of pERK-immunoreactive cells following low-dose capsaicin (0.33 µM) application to the tongue was significantly greater in the middle portion of the Vc of CIH rats than of normoxic rats and recovered under normoxic conditions after CIH. These data suggest that CIH during the sleep (light) phase is sufficient to transiently enhance pain on the ocular surface and intraoral mucosa via TRPV1-dependent mechanisms.
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