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Orock A, Johnson A, Mohammadi E, Greenwood-Van Meerveld B. Environmental enrichment reverses stress-induced changes in the brain-gut axis to ameliorate chronic visceral and somatic hypersensitivity. Neurobiol Stress 2024; 28:100590. [PMID: 38075024 PMCID: PMC10698671 DOI: 10.1016/j.ynstr.2023.100590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction Behavioral therapies, including cognitive behavioral therapy, hypnotherapy and stress management activities, have emerged as effective treatments for irritable bowel syndrome (IBS), a female predominant disorder of the brain-gut axis. IBS, affecting over 10% of the global population, typically presents with abnormal bowel habits and abdominal pain due to visceral hypersensitivity. While the mechanisms underlying how behavioral therapies treat IBS are still elusive, we had previously shown that chronic stress alters gene expression in brain regions critical for stress processing and nociception. We found that exposure to an enriched environment (EE), the rodent analogue of behavioral therapies, prior to and during the stressor was sufficient to prevent stress-induced changes in glucocorticoid receptor (GR) expression in the central nucleus of the amygdala (CeA) and hippocampus. Pre-exposure to EE also inhibited stress-induced increased colonic permeability and was able to block the induction of stress-induced visceral and somatic hypersensitivity. However, it remains unknown if EE can reverse chronic viscerosomatic hypersensitivity that persists following exposure to stress. We hypothesized that EE after chronic stress would be sufficient to reverse stress-induced changes in i) GR expression in the CeA and hippocampus, ii) ameliorate stress-induced colonic hyperpermeability and iii) restore normal visceral and somatic sensitivity in male and female rats. Methods Male and female rats were exposed to daily water avoidance stress (WAS). After confirming the rats had developed visceral hypersensitivity, 50% of the animals were housed in EE for 2 weeks while the other 50% remained in standard housing (SH). At the end of this period, we assessed visceral and somatic sensitivity. We also collected colon tissue to measure colonic permeability. Micro-punches of tissue from the CeA and hippocampus were isolated to measure GR expression. Control animals not exposed to WAS were kept in SH for the duration of the study (n = 8 per group). Results In both male and female rats, EE reversed stress-induced visceral (p < 0.001) and somatic (p < 0.01) hypersensitivity when compared to WAS animals housed in SH to levels comparable to control animals. EE exposure also reversed changes in GR expression in both the hippocampus (p < 0.01) and CeA (p < 0.01), normalizing GR expression to control levels. EE exposure ameliorated stress-induced colonic hyperpermeability in both male (p < 0.01) and female (p < 0.01) rats compared to WAS rats in SH. Conclusion Our findings suggest that behavioral therapies are viable therapeutic options for IBS as they can counter the stress-induced pathophysiology underlying IBS symptoms including visceral hypersensitivity, increased colonic permeability and altered gene expression.
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Affiliation(s)
- A. Orock
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - A.C. Johnson
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Health Care System, Oklahoma City, OK, USA
| | - E. Mohammadi
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - B. Greenwood-Van Meerveld
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Health Care System, Oklahoma City, OK, USA
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Kibret H, Assefa N, Eyeberu A, Debella A, Getachew T, Deressa A, Tamiru D, Bekele H, Habte S, Teji K. Nurses’ Knowledge and Practicing Level of Cognitive Behavioral Pain Relief Methods in Public Hospitals of Eastern Ethiopia. SAGE Open Nurs 2022; 8:23779608221138420. [PMID: 36425216 PMCID: PMC9679600 DOI: 10.1177/23779608221138420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Despite the fact that cognitive behavioral therapy is regarded as a superior
pain relief method and an alternative to drug therapy, little is known about
its scope of application and determinant factors. As a result, the study
sought to assess nurses’ knowledge and practicing level of cognitive
behavioral pain relief methods in public hospitals in eastern Ethiopia. Objective To assess the knowledge and practicing level of cognitive behavioral pain
relief among nurses working in public hospitals of eastern Ethiopia. Methods A cross-sectional study was conducted among randomly selected 390 nurses. The
data were collected using a self-administered questionnaire. The data were
entered into Epi-data 3.1 and exported to SPSS 22 for analysis. Bivariate
and multivariate logistic regression models were used to identify factors
associated with cognitive behavioral therapy. Result In this study, more than half (54.1%) of the respondents had good cognitive
behavioral methods practicing levels. Nearly two-thirds (58.8%) of the
participants had adequate knowledge about pain relief methods. Having
adequate knowledge (adjusted odds ratio [AOR] 2.664; 95% confidence interval
[CI]: 1.75, 4.7), having training (AOR 1.7; 95% CI: 1.03, 3.01), and
positive attitude (AOR 4.02; 95% CI: 4.5, 12.4) were significantly
associated with cognitive behavioral therapy. Conclusion In this study, more than half of nurses had good cognitive behavioral methods
practicing levels. Having a positive attitude, being knowledgeable, and
having training were determinant factors in the practice of cognitive
behavioral therapy. Continuing education and training should be considered
for nurses to enhance their cognitive behavioral therapy practice.
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Affiliation(s)
- Haregeweyn Kibret
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Tamiru
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sisay Habte
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Serra JRD, Souza LAF, Paz MGD, Tatagiba BDSF, Pereira LV. Sex Differences in Coping Strategies Based on Chronic Pain Intensity Among Older Adults. J Gerontol Nurs 2021; 47:30-36. [PMID: 34590979 DOI: 10.3928/00989134-20210908-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the current study was to investigate chronic pain coping strategies of older adults and the differences between sexes according to the intensity of pain. A cross-sectional study was performed in specialty clinics in midwestern Brazil. Participants comprised 276 older adults with chronic pain. The Brief Pain Inventory and Chronic Pain Coping Inventory-Brazilian version were used to assess self-reported pain intensity and pain coping strategies. Mann-Whitney U, Kruskal-Wallis, and Dunn tests were used for intergroup comparisons. The task persistence and coping self-statements subscales were the most used coping strategies. The strategies of exercise/stretching and task persistence were used differently between males and females. Males showed significant differences in asking for assistance, task persistence, and guarding subscales when pain intensity was taken into account, whereas females showed differences in the guarding and resting subscales. Adaptive coping was the most used coping strategy; however, some non-adaptive subscales were significant in both sexes when compared with levels of chronic pain intensity. [Journal of Gerontological Nursing, 47(10), 30-36.].
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Batho A, Kneale D, Sutcliffe K, Williams ACDC. Sufficient conditions for effective psychological treatment of chronic pain: a qualitative comparative analysis. Pain 2021; 162:2472-2485. [PMID: 34534175 DOI: 10.1097/j.pain.0000000000002242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic pain (CP) is the leading cause of years lived with disability globally. Treatment within Western medicine is often multicomponent; the psychological element of treatment varies, yet the optimal conditions for effective reduction of pain-related outcomes remain unclear. This study used qualitative comparative analysis, a relatively new form of evidence synthesis in the field based on set theory to ascertain configurations of intervention components and processes of psychological treatment of chronic pain in adults that lead to more effective interventions. Data were extracted from 38 studies identified in a concurrent Cochrane review and were then subjected to qualitative comparative analysis. Two analyses were conducted: one to examine what is most effective for reducing disability and one to examine what is most effective for reducing distress. Analysis and comparison of the 10 treatments with best outcomes with the 10 treatments with poorest outcomes showed that interventions using graded exposure, graded exercise or behavioural rehearsal (exposure/activity), and interventions aiming to modify reinforcement contingencies (social/operant) reduced disability levels when either approach was applied but not both. Exposure/activity can improve distress levels when combined with cognitive restructuring, as long as social/operant methods are not included in treatment. Clinical implications of this study suggest that treatment components should not be assumed to be synergistic and provided in a single package.
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Affiliation(s)
- Anna Batho
- Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Dylan Kneale
- IOE-Social Research Institute UCL Institute of Education, University College London, London, United Kingdom
| | - Katy Sutcliffe
- IOE-Social Research Institute UCL Institute of Education, University College London, London, United Kingdom
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
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McSwan J, Gudin J, Song XJ, Grinberg Plapler P, Betteridge NJ, Kechemir H, Igracki-Turudic I, Pickering G. Self-Healing: A Concept for Musculoskeletal Body Pain Management - Scientific Evidence and Mode of Action. J Pain Res 2021; 14:2943-2958. [PMID: 34584448 PMCID: PMC8464648 DOI: 10.2147/jpr.s321037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/21/2021] [Indexed: 12/16/2022] Open
Abstract
Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.
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Affiliation(s)
- Joyce McSwan
- GCPHN Persistent Pain Program, PainWISE, Gold Coast, QLD, Australia
| | - Jeffrey Gudin
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Xue-Jun Song
- SUSTech Center of Pain Medicine, School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
| | - Perola Grinberg Plapler
- Division of Physical Medicine, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Hayet Kechemir
- Consumer Healthcare Medical Affairs Department, Sanofi CHC, Paris, France
| | - Iva Igracki-Turudic
- Consumer Healthcare Medical Affairs Department, Sanofi CHC, Frankfurt, Germany
| | - Gisele Pickering
- Clinical Investigation Center CIC Inserm 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
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Orock A, Louwies T, Ligon CO, Mohammadi E, Greenwood-Van Meerveld B. Environmental enrichment prevents stress-induced epigenetic changes in the expression of glucocorticoid receptor and corticotrophin releasing hormone in the central nucleus of the amygdala to inhibit visceral hypersensitivity. Exp Neurol 2021; 345:113841. [PMID: 34390704 DOI: 10.1016/j.expneurol.2021.113841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Stress is a known trigger for the symptoms of irritable bowel syndrome (IBS), a gastrointestinal (GI) disorder that presents with abnormal bowel habits and abdominal pain due to visceral hypersensitivity. While behavioral therapies have been used to attenuate IBS symptoms, the underlying mechanisms by which these therapies interact with stress-induced pathology remains to be delineated. Here we use a rat model to test the hypothesis that exposure to environmental enrichment (EE) inhibits stress-induced changes within the brain-gut axis to prevent visceral and somatic hypersensitivity and colonic hyperpermeability. METHODS Female rats (n = 8/group) were housed in EE one week before and one week during exposure to water avoidance stress (WAS) while controls were housed in standard cages (SH). One day after the final WAS exposure, colonic and somatic sensitivity were assessed by the visceromotor response (VMR) to colorectal distension (CRD) and withdrawal threshold elicited by an electronic von Frey on the hind paw of the rats respectively. All rats were returned to SH for 3 weeks before colonic and somatic sensitivity were reassessed on day 28. The rats were then immediately euthanized and the spinal cord was collected to assess changes in neuronal activation (assessed via ERK phosphorylation) in response to noxious CRD. A separate cohort of animals (n = 8/group) that did not undergo behavioral assessments was euthanized the day after the final WAS exposure and the central nucleus of the amygdala (CeA) was collected to investigate WAS and EE induced epigenetic changes at the glucocorticoid receptor (GR) and corticotrophin releasing hormone (CRH) promoter. The colon from these rats was also collected to assess colonic permeability via changes in transepithelial electrical resistance (TEER) in vitro. RESULTS Exposure to stress persistently increased VMR to CRD (P < 0.01) and decreased the hind paw withdrawal threshold (P < 0.001) in female rats. WAS also decreased TEER in the colon tissue of female rats (p = 0.05). In the CeA, WAS induced a decrease in histone acetylation at the GR promoter but increased histone acetylation at the CRH promoter and reduced GR-CRH interactions in the CeA. Analysis of the spinal cord showed that WAS increased CRD-evoked ERK phosphorylation in the dorsal horn. Exposure to EE prevented WAS-induced changes in the CeA, dorsal horn and colon respectively to prevent visceral and somatic hypersensitivity. CONCLUSION Our data reveals that behavioral therapies can produce long lasting molecular and epigenetic changes that can prevent stress-induced pathologies even after completion of the therapy. These results highlight the potential mechanisms by which behavioral therapies may ameliorate visceral pain associated stress-related pathologies such as the irritable bowel syndrome.
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Affiliation(s)
- A Orock
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America.
| | - T Louwies
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - C O Ligon
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - E Mohammadi
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - B Greenwood-Van Meerveld
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America; Department of Veterans Affairs Health Care System, Oklahoma City, OK, United States of America
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Van Bogaert W, Putman K, Coppieters I, Goudman L, Nijs J, Moens M, Buyl R, Ickmans K, Huysmans E. Health-related quality of life deviations from population norms in patients with lumbar radiculopathy: associations with pain, pain cognitions, and endogenous nociceptive modulation. Qual Life Res 2021; 31:745-757. [PMID: 34342846 DOI: 10.1007/s11136-021-02964-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation. METHODS Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing. RESULTS One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of - 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: - 0.27 to - 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = - 0.002; 95% CI: - 0.004 to - 0.001]. CONCLUSION People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.
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Affiliation(s)
- Wouter Van Bogaert
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Research Foundation-Flanders (FWO), Brussels, Belgium.
| | - Koen Putman
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Lisa Goudman
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
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Saxena AK, Bhardwaj N, Chilkoti GT, Malik A, Thakur GK, Bajaj M, Banerjee A, Banerjee BD, Singhal A. Modulation of mRNA expression of IL-6andmTORC1 and efficacy and feasibility of an integrated approach encompassing cognitive behavioral therapy along with Pregabalin for management of neuropathic pain in Postherpetic Neuralgia: A Pilot Study. PAIN MEDICINE 2021; 22:2276-2282. [PMID: 34097069 DOI: 10.1093/pm/pnab142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study was designed to explore the efficacy and feasibility of cognitive behavioural therapy(CBT) along with pregabalin and compare it with pregabalin monotherapy for the management of neuropathic pain in post-herpetic neuralgia (PHN) patients and to explore the modulation of mRNA expression of interleukin (IL)-6 and mammalian target of rapamycin-1 (mTORC1) genes in these patients. DESIGN Randomized controlled pilot study. METHODS The patients aged >18 years of age with an established diagnosis of PHN with evident allodynia and hyperalgesia who had pain for at least 3 months after healing of rash with pain intensity ≥4/10 on NRS-Pain Scale were enrolled. The trial was registered with the Clinical Trials Registry-India (CTRI/2019/03/018014). A detailed baseline assessment regarding type and duration of pain and disability using pain-relevant self-report questionnaires was done. Two ml venous blood samples were collected for gene expression studies at base line and at end of 12 weeks of treatment. Patients were randomized into one of the two groups. Group PR received pregabalin and Group CP received CBT along with pregabalin. The pain intensity was measured using numeric rating scale (NRS)-Pain scale, neuropathic component of the pain by using Neuropathic Pain Symptom Inventory (NPSI) and Pain Detect Questionnaire (PDQ), sleep interference by NRS-Sleep, pain-related catastrophic thoughts by using Pain Catastrophizing Scale (PCS), depression and quality of life using Beck Depression Inventory-II (BDI-II) and Short Form-12 (SF-12), respectively. The research funding was supported by the intramural grant from the institution. RESULTS A total of 40 patients with 20 in each group were included. Following integrated approach encompassing CBT and Pregabalin, group CP had significant downregulation of mRNA expression of IL-6; however, no such correlation was observed with mTOR expression. A significant decline in the intensity of pain, NPSI scoring for burning, allodynia, and pain-related catastrophizing were observed; also a significant improvement in depressive symptoms and quality of life were observed with the use of CBT. CONCLUSIONS A significant downregulation of mRNA expression of IL-6 was observed; however, no significant correlation was observed between NRS pain score and ΔCt values of mRNA expression of both mTORC1 gene and IL-6 gene at baseline and at the end of 12th week. In addition, we note a significant decrease in pain intensity, depressive symptoms, and pain-related catastrophizing while improving QOL was observed with the use of CBT as a clinical adjunct along with pregabalin in PHN patients.
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Affiliation(s)
- Ashok Kumar Saxena
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Neha Bhardwaj
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Geetanjali T Chilkoti
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Anish Malik
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Gaurav Kumar Thakur
- Department of Biochemistry, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Megha Bajaj
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Anwesha Banerjee
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Basu Dev Banerjee
- Department of Biochemistry, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
| | - Archana Singhal
- Department of Dermatology, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, -110095, India
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Orock A, Yuan T, Greenwood-Van Meerveld B. Importance of Non-pharmacological Approaches for Treating Irritable Bowel Syndrome: Mechanisms and Clinical Relevance. FRONTIERS IN PAIN RESEARCH 2021; 1:609292. [PMID: 35295688 PMCID: PMC8915633 DOI: 10.3389/fpain.2020.609292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic visceral pain represents a major unmet clinical need with the severity of pain ranging from mild to so severe as to prevent individuals from participating in day-to-day activities and detrimentally affecting their quality of life. Although chronic visceral pain can be multifactorial with many different biological and psychological systems contributing to the onset and severity of symptoms, one of the major triggers for visceral pain is the exposure to emotional and physical stress. Chronic visceral pain that is worsened by stress is a hallmark feature of functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Current pharmacological interventions for patients with chronic visceral pain generally lack efficacy and many are fraught with unwanted side effects. Cognitive behavioral therapy (CBT) has emerged as a psychotherapy that shows efficacy at ameliorating stress-induced chronic visceral pain; however, the molecular mechanisms underlying CBT remain incompletely understood. Preclinical studies in experimental models of stress-induced visceral pain employing environmental enrichment (EE) as an animal model surrogate for CBT are unraveling the mechanism by which environmental signals can lead to long-lasting changes in gene expression and behavior. Evidence suggests that EE signaling interacts with stress and nociceptive signaling. This review will (1) critically evaluate the behavioral and molecular changes that lead to chronic pain in IBS, (2) summarize the pharmacological and non-pharmacological approaches used to treat IBS patients, and (3) provide experimental evidence supporting the potential mechanisms by which CBT ameliorates stress-induced visceral pain.
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Affiliation(s)
- Albert Orock
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Tian Yuan
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Beverley Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Oklahoma City VA Health Care System, Oklahoma City, OK, United States
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Beverley Greenwood-Van Meerveld
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Patients' perspective on cognitive behavioural therapy after surgical treatment of endometriosis: a qualitative study. Reprod Biomed Online 2021; 42:819-825. [PMID: 33602590 DOI: 10.1016/j.rbmo.2021.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION Would adding cognitive behavioural therapy (CBT) to the treatment of endometriosis improve the quality of life of patients suffering from endometriosis-associated pain? The aim of this study was to identify if patients believed CBT should be added to endometriosis treatment and which form of CBT they would prefer: face-to-face individual or group, or web-based individual, sessions. DESIGN Between November 2019 and January 2020, semi-structured focus groups were conducted using an interview guide to ensure all topics were discussed. Data collection was continued until saturation was obtained. The focus groups were transcribed word for word and openly encoded. Finally, themes were formulated. RESULTS All participating women believed CBT should be offered to patients undergoing endometriosis surgery. They believed it could be an asset to improve quality of life. Participants preferred either in-person individual or group therapy. They stressed the importance of being offered a custom-made treatment plan, individually tailored to the different needs of different patients. CONCLUSION This study has shown that patients with endometriosis believe that CBT should be added to the standard treatment regimen of endometriosis in either group or individual face-to-face sessions, because they expect that CBT will improve their quality of life after surgery.
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Cultural adaptations of cognitive behavioural therapy for Latin American patients: unexpected findings from a systematic review. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractThe current literature extensively recommends making cultural adaptations to psychological therapies, in order to address the differences in values, beliefs and attitudes that patients from different ethnic groups might hold. Although this approach has shown positive outcomes in some settings, it is not well established yet whether such adaptations are needed for all therapies and in all cultures. Therefore, the main aim of this study was to systematically review the literature regarding culturally adapted and ‘conventional’ cognitive behavioural therapy (CBT) for Latin American patients, within Latin American and non-Latin American countries. Sixty empirical studies regarding the effectiveness of culturally adapted and conventional CBT were included in this review. The included studies were carried out in Latin American and non-Latin American countries. The information from all studies was synthesized and assessed, including intervention effect sizes, patient retention rates, methodological quality of the papers, and the type of cultural adaptation made to the therapy. There were no differences between the sets of studies in terms of effectiveness, retention rates, methodological quality, or proportion of statistically significant interventions. Most of the cultural adaptations were peripheral or unspecified. The evidence to date indicates that both conventional and culturally adapted CBT offer the same benefits for Latin American patients in terms of effectiveness and retention rates. Rather than focusing on cultural adaptations, clinicians are encouraged to improve the way they deliver CBT through training and supervision.Key learning aims(1)Cultural adaptations of CBT do not seem to offer any significant benefits to conventional, non-adapted CBT in Latin American patients.(2)Most of the adaptations made to CBT for Latin American patients are either peripheral or not disclosed.(3)We discuss the implications of adapting CBT for Latin American patients when there is no apparent need to do so.
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Roslyakova T, Falco MA, Gauchet A. An exploratory clinical trial on acceptance and commitment therapy as an adjunct to psychoeducational relaxation therapy for chronic pain. Psychol Health 2020; 36:1403-1426. [PMID: 33297730 DOI: 10.1080/08870446.2020.1856844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: The aim of this study was to compare the clinical efficacy of two differently-designed psychological interventions for chronic pain.Design: 138 patients presenting chronic pain were randomly assigned to one of two experimental conditions: (1) Psychoeducational relaxation therapy (PRT, n = 84) or (2) PRT followed by acceptance and commitment therapy (PRT + ACT, n = 54).Main outcome measures: Pain intensity, quality of life (SF-36), anxiety and depression (HADS), stress (PSS), pain catastrophizing (PCS), chronic pain acceptance (CPAQ), and psychological inflexibility (PIPS) were assessed at three time-points: before therapy (T1); at the end of the therapy (T2); and 3- months after the end of the therapy (T3).Results: In T2, the PRT intervention showed more significant improvements in the measures of mental quality of life [F (1,92) = 7.478, P < .05] and depression [F (1, 92) = 5.804, P < .05] compared to the PRT + ACT intervention. The experimental groups did not differ in their outcome measures at T3.Conclusion: PRT appears to be an effective solution in the psychological care of chronic pain. The effectiveness of this type of intervention seems to have been underestimated. The addition of ACT sessions did not significantly impact the results, indicating that both designs of interventions are effective in the short term.
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Affiliation(s)
- Tamila Roslyakova
- Epsylon EA4556, Dynamic of Human Abilities and Health Behaviors, University of Paul Valery Montpellier 3, Montpellier, France.,Plateforme CEPS, University of Montpellier, Montpellier, France
| | | | - Aurélie Gauchet
- Inter-University Psychology Laboratory, University Grenoble Alpes, Grenoble, France
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13
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Rababa M, Alhawatmeh H, Al Ali N, Kassab M. Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2020; 45:355-366. [PMID: 33100426 PMCID: PMC7573866 DOI: 10.1007/s10608-020-10167-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
Background Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses. Methods A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students’ responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393). Results Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group. Conclusions CBT is an effective evidence-based psychological intervention for relieving nurses’ ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses’ accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended. Electronic supplementary material The online version of this article (10.1007/s10608-020-10167-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad Rababa
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology/School of Nursing, P O Box 3030, Irbid, 22110 Jordan
| | - Hossam Alhawatmeh
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology/School of Nursing, P O Box 3030, Irbid, 22110 Jordan
| | - Nahla Al Ali
- Department of Community and Psychiatric Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Manal Kassab
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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14
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Williams ACDC, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2020; 8:CD007407. [PMID: 32794606 PMCID: PMC7437545 DOI: 10.1002/14651858.cd007407.pub4] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012. OBJECTIVES To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU). SEARCH METHODS We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials. SELECTION CRITERIA RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end. DATA COLLECTION AND ANALYSIS Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment. MAIN RESULTS We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-quality evidence), but none for disability (SMD -1.39, 95% CI -3.20 to 0.41, very low-quality evidence), or distress (SMD -1.16, 95% CI -2.51 to 0.20, very low-quality evidence). Lack of data precluded analysis at follow-up. We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low-quality evidence because the estimates are uncertain and could be easily overturned. AUTHORS' CONCLUSIONS We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.
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Affiliation(s)
- Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | - Leslie Hearn
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
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15
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Orock A, Louwies T, Yuan T, Greenwood-Van Meerveld B. Environmental enrichment prevents chronic stress-induced brain-gut axis dysfunction through a GR-mediated mechanism in the central nucleus of the amygdala. Neurogastroenterol Motil 2020; 32:e13826. [PMID: 32084303 PMCID: PMC7906280 DOI: 10.1111/nmo.13826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) improves quality of life of patients with irritable bowel syndrome (IBS), a disorder characterized by chronic visceral pain and abnormal bowel habits. Whether CBT can actually improve visceral pain in IBS patients is still unknown. The aim of this study is to evaluate whether environment enrichment (EE), the animal analog of CBT, can prevent stress-induced viscero-somatic hypersensitivity through changes in glucocorticoid receptor (GR) signaling within the central nucleus of the amygdala (CeA). METHODS Rats were housed in either standard housing (SH) or EE for 7 days before and during daily water avoidance stress (WAS) exposure (1-h/d for 7 days). In the first cohort, visceral and somatic sensitivity were assessed via visceromotor response to colorectal distention and von Frey Anesthesiometer 24 hous and 21 days after WAS. In another cohort, the CeA was isolated for GR mRNA quantification. KEY RESULTS Environment enrichment for 7 days before and during the 7 days of WAS persistently attenuated visceral and somatic hypersensitivity when compared to rats placed in SH. Environment enrichment exposure also prevented the WAS-induced decrease in GR expression in the CeA. CONCLUSION & INFERENCES Pre-exposure to short-term EE prevents the stress-induced downregulation of GR, and inhibits visceral and somatic hypersensitivity induced by chronic stress. These results suggest that a positive environment can ameliorate stress-induced pathology and provide a non-pharmacological therapeutic option for disorders such as IBS.
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Affiliation(s)
- A Orock
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - T Louwies
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - T Yuan
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - B Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK,,Department of Veterans Affairs Health Care System, Oklahoma City, OK.,Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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16
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Rezaei S, Abedi P, Maraghi E, Hamid N, Rashidi H. The effectiveness of cognitive- behavioral therapy on quality of life in women with hypothyroidism in the reproductive age: a randomized controlled trial. Thyroid Res 2020; 13:6. [PMID: 32467735 PMCID: PMC7238494 DOI: 10.1186/s13044-020-00080-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Worldwide, hypothyroidism affects 3.7% of the population, and is associated with impaired quality of life. This study aimed to evaluate the effect of cognitive- behavioral therapy (CBT) on the quality of life in women with hypothyroidism. Methods 96 women with hypothyroidism randomly allocated into two groups: CBT group (n = 48) and control group (n = 48). Women in the CBT group were classified into four sub-groups of 12, and each sub-group received eight sessions of counseling (each session lasting 90 min). We collected data using a demographic questionnaire and the 36-Item Short Form Health Survey (SF 36) for measuring the quality of life. We used the independent t-test, chi-square test and ANCOVA to analyze the data. Results Five women from each group withdrew from the study, leaving 43 women in each group. The scores on physical functioning, physical health problems, social functioning and pain improved in the CBT group after the intervention, but the differences between the two groups were not significant. The scores on emotional health, emotional health problems, energy and emotions, and general health were significantly better in the CBT group than those in the control group (p < 0.05). Conclusion Counseling using CBT can improve some aspects of quality of life, including emotional health, emotional health problems, energy and general health in patients with hypothyroidism. Trial registration number Iranian Registry for Clinical Trials: 20190323043101 N1. https://www.irct.ir/
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Affiliation(s)
- Sohaila Rezaei
- 1MS. c Candidate in Midwifery Department, Reproductive Health Promotion Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Abedi
- 2PhD in Community Nutrition, Associate Professor in Midwifery Department, Menopause Andropause Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- 3PhD of Biostatistics, Assistant Professor, Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmeh Hamid
- 4Associate Professor of Clinical Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Homaira Rashidi
- 5Associate Professor in Endocrinology Department, Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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17
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Hosogoshi H, Iwasa K, Fukumori T, Takagishi Y, Takebayashi Y, Adachi T, Oe Y, Tairako Y, Takao Y, Nishie H, Kanie A, Kitahara M, Enomoto K, Ishii H, Shinmei I, Horikoshi M, Shibata M. Pilot study of a basic individualized cognitive behavioral therapy program for chronic pain in Japan. Biopsychosoc Med 2020; 14:6. [PMID: 32175003 PMCID: PMC7063808 DOI: 10.1186/s13030-020-00176-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Chronic pain is a major health problem, and cognitive behavioral therapy (CBT) is its recommended treatment; however, efforts to develop CBT programs for chronic pain and assess their feasibility are remarkably delayed in Asia. Therefore, we conducted this pilot study to develop a basic individualized CBT for chronic pain (CBT-CP) and assessed its feasibility for use in Japan. Methods Our study was an open-labeled before–after trial without a control group conducted cooperatively in five Japanese tertiary care hospitals. Of 24 outpatients, 15, age 20–80, who experienced chronic pain for at least three months were eligible. They underwent an eight-session CBT-CP consisting of relaxation via a breathing method and progressive muscle relaxation, behavioral modification via activity pacing, and cognitive modification via cognitive reconstruction. The EuroQol five-dimensional questionnaire five level (EQ5D-5 L) assessment as the primary outcome and quality of life (QOL), pain severity, disability, catastrophizing, self-efficacy, and depressive symptoms as secondary outcomes were measured using self-administered questionnaires at baseline, post-treatment, and 3-month follow-up. Intention-to-treat analyses were conducted. Results Effect size for EQ5D-5 L score was medium from baseline to post-treatment (Hedge’s g = − 0.72, 90% confidence interval = − 1.38 to − 0.05) and up to the 3-month follow-up (g = − 0.60, CI = − 1.22 to 0.02). Effect sizes for mental and role/social QOL, disability, catastrophizing, self-efficacy, and depressive symptoms were medium to large, although those for pain severity and physical QOL were small. The dropout rate was acceptably low at 14%. No severe adverse events occurred. Conclusion The findings suggest that CBT-CP warrants a randomized controlled trial in Japan. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000020880. Registered on 04 February 2016.
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Affiliation(s)
- Hiroki Hosogoshi
- 1Department of Sociology, Faculty of Sociology, Kansai University, 3-3-35 Yamate-cho, Suita-shi, Osaka, 564-8680 Japan.,2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Kazunori Iwasa
- 3Faculty of Education, Shujitsu University, 1-6-1 Nishigawara, Naka-ku, Okayama-shi, Okayama, 703-8516 Japan
| | - Takaki Fukumori
- 4Graduate School of Integrated Arts and Sciences, Tokushima University, 1-1 Minamijosanjima-cho, Tokushima-shi, Tokushima, 770-8502 Japan
| | - Yuriko Takagishi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,5Department of Psychology, Surugadai University, 698 Azu, Hanno-shi, Saitama, 357-8555 Japan
| | - Yoshitake Takebayashi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,6Department of Health Risk Communication, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Tomonori Adachi
- 7Pain Management Clinic, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu-shi, Shiga 520-2192 Japan
| | - Yuki Oe
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,8Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611 Japan
| | - Yukino Tairako
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,9Department of Psychology, Meiji Gakuin University, 1-2-37 Shirokanedai, Minato-ku, Tokyo, 108-8636 Japan
| | - Yumiko Takao
- 10Department of Pain Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501 Japan
| | - Hiroyuki Nishie
- 11Anesthesiology and Intensive Care 2, Kawasaki Medical School, 577 Matsushima, Kurashiki-shi, Okayama, 701-0192 Japan
| | - Ayako Kanie
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Masaki Kitahara
- 12Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama-shi, Kanagawa 232-0024 Japan
| | - Kiyoka Enomoto
- 13Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita-shi, Osaka, 565-0871 Japan
| | - Hirono Ishii
- 14Counseling Office, Japan Women's University, 1-1-1 Nishiikuta, Tama-ku, Kawasaki-shi, Kanagawa 214-8565 Japan
| | - Issei Shinmei
- 15Department of Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8553 Japan.,TCBT Counseling Office, Cosmos Kichijoji Building 2F, 2-8-4 Kichijojihoncho, Musashino-shi, Tokyo, 180-0004 Japan
| | - Masaru Horikoshi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Masahiko Shibata
- 17Department of Health Science, Naragakuen University, 3-15-1 Nakatomigaoka, Nara-shi, Nara, 631-8524 Japan
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Ampiah PK, Hendrick P, Moffatt F, Ahenkorah J. Operationalisation of a biopsychosocial approach for the non-pharmacological management of patients with chronic musculoskeletal pain in low- and middle-income countries: A systematic review. Musculoskeletal Care 2020; 18:227-244. [PMID: 32056363 DOI: 10.1002/msc.1462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic musculoskeletal pain is a major health concern. The biopsychosocial approach is an evidence-based approach recommended for managing chronic musculoskeletal pain. However, the evidence for this approach is largely reported from high-income countries; therefore, it is important to ascertain how biopsychosocial approaches are operationalised in low- and middle-income countries to inform practice. AIM To examine the evidence for the operationalization of biopsychosocial interventions in managing patients with chronic musculoskeletal pain in low-and middle-income countries. METHODS The search included studies published in English from 2008 to September 2019 in: Cochrane library, OVID, CINAHL, Scopus, PUBMED, Web of Science, and SportDiscus. Randomised and non-randomised trials using a biopsychosocial intervention were considered. The review team developed a search strategy; two independent reviewers screened and assessed results for quality. RESULTS Sixteen studies were included (n = 996) with mainly low back pain populations (n = 11 studies). Others were osteoarthritis (n = 1) and other musculoskeletal pain (n = 4). The majority (n = 12) of studies attained fair to poor quality, three had good quality, one scored excellent quality. Interventions applied biopsychosocial principles such as cognitive functional therapy, and graded activity, delivered by healthcare professionals such as physiotherapists and doctors. However, most results provided insufficient information regarding healthcare professionals' capacity to deliver interventions, lack of information regarding intervention delivery and training of healthcare professionals. CONCLUSIONS The results highlight the potential for delivering biopsychosocial interventions in low- and middle-income countries; however, future research should consider robust methodological approaches with clear details to achieve high-quality trials.
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Affiliation(s)
- Paapa Kwesi Ampiah
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Josephine Ahenkorah
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
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Abstract
BACKGROUND Centers for Disease Control and Prevention guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients have not been described in a national population. METHODS We assessed OpRx prevalence among prevalent KTx recipients, and associated duration (long-term, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment. Cox models controlled for recipient factors. RESULTS Of 36,486 KTx recipients in the 2010 prevalent cohort, approximately 14.6% had long-term OpRx. The strongest association with long-term OpRx after KTx was long-term OpRx before KTx (64%; adjusted odds ratio, 95% confidence interval, 95.2, 74.2-122.1). Incident KTx recipients with long-term OpRx had increased risk of mortality and graft loss compared with those without OpRx or short-term OpRx after KTx. This risk was highest among recipients with long-term OpRx doses of ≥90 morphine milligram equivalents or higher per day (adjusted hazard ratio, 95% confidence interval, 1.61, 1.24-2.10 for death, and 1.33, 1.05-1.67 for graft loss, respectively). CONCLUSIONS In contrast to either no or short-term OpRx, long-term, and especially long-term high-dose OpRx, is associated with increased risk of death and graft loss in US KTx recipients. Causal relationships cannot be inferred, and OpRx may be an illness marker. Nevertheless, efforts to treat pain effectively in KTx recipients with less toxic interventions and decrease OpRx deserve consideration.
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Moura CDC, Chaves ÉDCL, Cardoso ACLR, Nogueira DA, Corrêa HP, Chianca TCM. Cupping therapy and chronic back pain: systematic review and meta-analysis. Rev Lat Am Enfermagem 2018; 26:e3094. [PMID: 30462793 PMCID: PMC6248735 DOI: 10.1590/1518-8345.2888.3094] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/17/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the evidence from the literature regarding the effects of cupping therapy on chronic back pain in adults, the most used outcomes to evaluate this condition, the protocol used to apply the intervention and to investigate the effectiveness of cupping therapy on the intensity of chronic back pain. METHOD systematic review and meta-analysis carried out by two independent researchers in national and international databases. Reference lists of systematic reviews were also explored. The quality of evidence was assessed according to the Jadad scale. RESULTS 611 studies were identified, of which 16 were included in the qualitative analysis and 10 in the quantitative analysis. Cupping therapy has shown positive results on chronic back pain. There is no standardization in the treatment protocol. The main assessed outcomes were pain intensity, physical incapacity, quality of life and nociceptive threshold before the mechanical stimulus. There was a significant reduction in the pain intensity score through the use of cupping therapy (p = 0.001). CONCLUSION cupping therapy is a promising method for the treatment of chronic back pain in adults. There is the need to establish standardized application protocols for this intervention.
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21
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Shaikh M, Hapidou EG. Factors involved in patients’ perceptions of self-improvement after chronic pain treatment. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2018; 2:145-157. [PMID: 35005374 PMCID: PMC8730591 DOI: 10.1080/24740527.2018.1476821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Patients’ self-reported levels of improvement after having attended a chronic pain management program can provide a subjective rating of how successful they perceive they were at accomplishing their goals in the program. Past studies have demonstrated that successful patients differ from less successful ones on several cognitive–behavioral factors such as coping strategies over physical characteristics such as pain intensity. Aims This study explored factors that determine patients’ perceptions of self-improvement after undergoing chronic pain treatment in a pain management program. Methods Participants (n = 174) underwent a 4-week, interdisciplinary, multimodal, chronic pain management program at a hospital located in southern Ontario. Questionnaire packages that evaluate pain intensity, pain-related disability, emotional distress (e.g., depression, anxiety, catastrophizing), acceptance of pain (activity engagement and pain willingness), readiness to change, and use of adaptive or maladaptive coping strategies were completed by patients at admission and discharge. Participants were grouped into one of three categories depending on their rating of self-improvement on the Self-Evaluation Scale (SES). The groups were compared on the magnitude of change they reported on the variables mentioned above. Results Changes in emotional distress, general health, readiness to change, activity engagement, and adaptive coping strategies (e.g., task persistence, pacing, and seeking social support) were significantly associated with differences in ratings of self-improvement. Conclusions This study provided insight into what patients value most when rating their self-improvement, which can then be used to facilitate increased patient success and satisfaction with treatment.
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Affiliation(s)
- Majidullah Shaikh
- Department of Psychology, Neuroscience and Behaviour (PNB), McMaster University , Hamilton, ON, Canada
| | - Eleni G. Hapidou
- Department of Psychology, Neuroscience and Behaviour (PNB), McMaster University , Hamilton, ON, Canada
- Michael G. DeGroote Pain Clinic, McMaster University Medical Centre , Hamilton, ON, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University , Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University , Hamilton, ON, Canada
- Bachelor of Health Sciences (Honour’s) Program, McMaster University , Hamilton, ON, Canada
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22
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Lim JA, Choi SH, Lee WJ, Jang JH, Moon JY, Kim YC, Kang DH. Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy. Medicine (Baltimore) 2018; 97:e10867. [PMID: 29879022 PMCID: PMC5999451 DOI: 10.1097/md.0000000000010867] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Chronic pain is defined as persistent or recurrent pain lasting longer than 3 months; the severity of pain can be rated in terms of intensity, pain-related distress, and functional impairment. Researches have shown an association between psychosocial factors, such as empathic ability, and the severity of pain. Cognitive-behavioral therapy (CBT) is the most common psychologic intervention for individuals with chronic pain. The aim of this study was to investigate the effect of CBT on empathy in chronic pain patients, examining especially gender differences. In total, 89 patients with severe chronic pain (46 men and 43 women) underwent 8 sessions of CBT over the course of 4 weeks. Self-reported clinical symptoms were measured at the beginning and end of the CBT. Empathy was measured using the interpersonal reactivity index, and pain severity was assessed using the short-form McGill pain questionnaire. A comparison of male and female patients before CBT indicated that females showed higher levels of empathy in response to affective issues and reported greater affective pain than males. A mixed analysis of variance revealed that female patients showed higher levels of empathy than did male patients, both before and after CBT. We also found significant relationships between affective pain and empathy for others' personal distress in all patients. These results suggest that the effectiveness of CBT may be affected by chronic pain patients' level of empathy. Although the evident result was not shown in this study, the present findings imply that female patients may formulate excellent therapeutic alliance in CBT intervention that can lead to a clinical benefit.
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Affiliation(s)
- Jae-A Lim
- Department of Psychiatry, Seoul National University Hospital
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital
- Department of Psychiatry, Seoul National University College of Medicine, Seoul
| | - Won Joon Lee
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University Hospital
- Department of Medicine, Seoul National University College of Medicine
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Hyung Kang
- Department of Psychiatry, Seoul National University Hospital
- Department of Psychiatry, Seoul National University College of Medicine, Seoul
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23
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Hughes JM, Seemann EA, George JM, Willis KD. The Effects of Pre-treatment Depressive Symptoms on Quality of Life Across Cognitive Behavioral Therapy for Chronic Pain. J Clin Psychol Med Settings 2018; 26:97-105. [PMID: 29777343 DOI: 10.1007/s10880-018-9568-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Recent studies suggest that chronic pain affects millions and carries significant physical, financial, and social burdens, and thus adversely affects quality of life (QOL). Cognitive behavioral therapy for chronic pain (CBTp) is a non-pharmacological treatment method which has been shown to reduce a sufferer's experience of chronic pain and improve overall QOL. These and other studies also indicate that affective symptoms likely impact the effectiveness of CBTp. The current study focused on the effects of depressive symptoms on changes in QOL ratings across a 12-session CBT for chronic pain. Participants in this study (n = 313; mean age = 46.83 years, SD = 10.99, range = 19.1-79.9, 63.9% female, 83.9% Caucasian) were current patients of a mid-sized tertiary multidisciplinary outpatient chronic pain treatment facility. Progress through CBTp was assessed using QOL as a dependent variable and analyzed using RMANOVAs. All participants showed improvements in QOL ratings across the CBTp period, but greater improvements were seen in participants in the low depression category than in the high or moderate depression category. This study also confirms the clinical utility of the BDI-II with chronic pain patients.
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Affiliation(s)
- Justin M Hughes
- Department of Psychology, The University of Alabama in Huntsville, Huntsville, AL, USA.
| | - Eric A Seemann
- Department of Psychology, The University of Alabama in Huntsville, Huntsville, AL, USA
- Covenant Pain Therapies Center, Huntsville, AL, USA
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24
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Kimmel PL, Fwu CW, Abbott KC, Eggers AW, Kline PP, Eggers PW. Opioid Prescription, Morbidity, and Mortality in United States Dialysis Patients. J Am Soc Nephrol 2017; 28:3658-3670. [PMID: 28935654 DOI: 10.1681/asn.2017010098] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/08/2017] [Indexed: 11/03/2022] Open
Abstract
Aggressive pain treatment was advocated for ESRD patients, but new Centers for Disease Control and Prevention guidelines recommend cautious opioid prescription. Little is known regarding outcomes associated with ESRD opioid prescription. We assessed opioid prescriptions and associations between opioid prescription and dose and patient outcomes using 2006-2010 US Renal Data System information in patients on maintenance dialysis with Medicare Part A, B, and D coverage in each study year (n=671,281, of whom 271,285 were unique patients). Opioid prescription was confirmed from Part D prescription claims. In the 2010 prevalent cohort (n=153,758), we examined associations of opioid prescription with subsequent all-cause death, dialysis discontinuation, and hospitalization controlled for demographics, comorbidity, modality, and residence. Overall, >60% of dialysis patients had at least one opioid prescription every year. Approximately 20% of patients had a chronic (≥90-day supply) opioid prescription each year, in 2010 usually for hydrocodone, oxycodone, or tramadol. In the 2010 cohort, compared with patients without an opioid prescription, patients with short-term (1-89 days) and chronic opioid prescriptions had increased mortality, dialysis discontinuation, and hospitalization. All opioid drugs associated with mortality; most associated with worsened morbidity. Higher opioid doses correlated with death in a monotonically increasing fashion. We conclude that opioid drug prescription is associated with increased risk of death, dialysis discontinuation, and hospitalization in dialysis patients. Causal relationships cannot be inferred, and opioid prescription may be an illness marker. Efforts to treat pain effectively in patients on dialysis yet decrease opioid prescriptions and dose deserve consideration.
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Affiliation(s)
- Paul L Kimmel
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;
| | - Chyng-Wen Fwu
- Social and Scientific Systems, Inc., Silver Spring, Maryland
| | - Kevin C Abbott
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Prudence P Kline
- Department of Medicine, George Washington University, Washington, DC
| | - Paul W Eggers
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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25
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Höfel L, Draheim N, Häfner R, Haas JP. [Pain syndrome of the musculoskeletal system in children and adolescents]. Z Rheumatol 2017; 75:292-302. [PMID: 26892925 DOI: 10.1007/s00393-016-0061-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic pain syndromes in children and adolescents are defined as continuous or recurrent pain without an underlying causative diagnosis and lasting for more than 3 months. It is estimated that every fourth child in Germany suffers from chronic pain with every twentieth suffering from extreme recurrent pain. The incidence of chronic pain in children and adolescents is increasing with headache, abdominal pain and musculoskeletal pain being the most frequent. The quality of life declines not only due to the pain but to relieving postural and psychological factors, such as fear and sadness. School attendance, social activities and hobbies are mostly affected. This review summarizes the background of chronic pain syndromes and introduces a multimodal therapeutic approach.
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Affiliation(s)
- L Höfel
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - N Draheim
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - R Häfner
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - J P Haas
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland.
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26
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Lemstra ME, Rogers MR. Improving health-related quality of life through an evidence-based obesity reduction program: the Healthy Weights Initiative. J Multidiscip Healthc 2016; 9:103-9. [PMID: 27022273 PMCID: PMC4788365 DOI: 10.2147/jmdh.s100693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
When evaluating any health intervention, it is critical to include the impact of the intervention on health-related quality of life (HRQL). Among those who are obese, HRQL is often lower than the general population and even more when considering obesity-related comorbidities and bodily pain. The objectives of this paper were to determine the impact of a multidisciplinary, community-based obesity reduction program on HRQL and to determine the independent risk factors for lack of improvement from baseline to follow-up. HRQL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline and follow-up (24 weeks). To date, 84.5% of those who completed the program had improvements in their overall SF-36 score. Significant increases in the mean scores on eight dimensions of health were also observed. Lack of improvement was independently affected by smoking status (odds ratio 3.75; 95% confidence interval 1.44–9.78; P=0.007) and not having a buddy to attend the program (odds ratio 3.70; 95% confidence interval 1.28–10.68; P=0.015). Obesity reduction programs that target increasing exercise, improving diet, and cognitive behavioral therapy can positively impact HRQL in obese adults. Social support has a strong role to play in improving outcomes.
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Affiliation(s)
| | - Marla R Rogers
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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27
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Fariello JY, Moldwin RM. Similarities between interstitial cystitis/bladder pain syndrome and vulvodynia: implications for patient management. Transl Androl Urol 2016; 4:643-52. [PMID: 26816866 PMCID: PMC4708545 DOI: 10.3978/j.issn.2223-4683.2015.10.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) and vulvodynia are chronic pain syndromes that appear to be intertwined from the perspectives of embryology, pathology and epidemiology. These associations may account for similar responses to various therapies.
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Affiliation(s)
- Jennifer Yonaitis Fariello
- 1 Academic Urology at Bryn Mawr, The Center for Pelvic Medicine, Rosemont, PA, USA ; 2 Hofstra North Shore-LIJ School of Medicine, Pelvic Pain Treatment Center, The Arthur Smith Institute for Urology, North Shore-LIJ Healthcare System, New Hyde Park, NY, USA
| | - Robert M Moldwin
- 1 Academic Urology at Bryn Mawr, The Center for Pelvic Medicine, Rosemont, PA, USA ; 2 Hofstra North Shore-LIJ School of Medicine, Pelvic Pain Treatment Center, The Arthur Smith Institute for Urology, North Shore-LIJ Healthcare System, New Hyde Park, NY, USA
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28
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Cajanding RJM. The Effectiveness of a Nurse-Led Cognitive-Behavioral Therapy on the Quality of Life, Self-Esteem and Mood Among Filipino Patients Living With Heart Failure: a Randomized Controlled Trial. Appl Nurs Res 2016; 31:86-93. [PMID: 27397824 DOI: 10.1016/j.apnr.2016.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/10/2016] [Accepted: 01/14/2016] [Indexed: 01/19/2023]
Abstract
AIMS/OBJECTIVES The diagnosis and complications associated with heart failure (HF) have been very well established to adversely impact an individual's physical and psychosocial well-being, and interventions such as cognitive-behavioral techniques have demonstrated potential positive benefits among patients with HF. However, the effects of such interventions among Filipino HF patients have not been studied. This study aimed to determine the effectiveness of a nurse-led cognitive-behavioral intervention program on the quality of life, self-esteem and mood among Filipino patients with HF. METHODS A randomized control two-group design with repeated measures and collected data before and after the intervention was used in this study. Participants were assigned to either the control (n=48) or the intervention group (n=52). Control group participants received traditional care. Intervention participants underwent a 12-week nurse-led cognitive-behavioral intervention program focusing on patient education, self-monitoring, skills training, cognitive restructuring and spiritual development. Measures of quality of life, self-esteem and mood were obtained at baseline and after the intervention. RESULTS At baseline, participants in both groups have poor quality of life, low self-esteem, and moderate depressive symptom scores. After the 12-week intervention period, participants in the intervention group had significant improvement in their quality of life, self-esteem and mood scores compared with those who received only standard care. CONCLUSION Nurse-led cognitive-behavioral intervention is an effective strategy in improving the quality of life, self-esteem and mood among Filipino patients living with HF. It is recommended that this intervention be incorporated in the optimal care of patients with this cardiac condition.
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Affiliation(s)
- Ruff Joseph Macale Cajanding
- Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, United Kingdom.
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29
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Knoerl R, Lavoie Smith EM, Weisberg J. Chronic Pain and Cognitive Behavioral Therapy. West J Nurs Res 2015; 38:596-628. [DOI: 10.1177/0193945915615869] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cognitive behavioral therapy (CBT) is often used to treat chronic pain; however, more information is needed about what are the most efficacious dose and delivery methods. The aims of this review were to determine (a) which CBT doses, delivery methods, strategies, and follow-up periods have been explored in recent intervention studies of individuals with chronic pain and (b) whether the outcomes described in the selected studies were consistent with recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. The CINAHL, EMBASE, PubMed, PsycInfo, and SCOPUS databases were searched for randomized controlled trials published from 2009 to 2015 testing CBT for adults with chronic pain. Thirty-five studies were included in this review. Results revealed that CBT reduced pain intensity in 43% of trials, the efficacy of online and in-person formats were comparable, and military veterans and individuals with cancer-related chronic pain were understudied.
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Affiliation(s)
- Robert Knoerl
- University of Michigan School of Nursing, Ann Arbor, USA
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30
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Lamerato LE, Dryer RD, Wolff GG, Hegeman-Dingle R, Mardekian J, Park PW, Zlateva G. Prevalence of Chronic Pain in a Large Integrated Healthcare Delivery System in the U.S.A. Pain Pract 2015. [DOI: 10.1111/papr.12334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Lois E. Lamerato
- Department of Public Health Sciences; Henry Ford Health System; Detroit Michigan U.S.A
| | - Richard D. Dryer
- Department of Internal Medicine; Henry Ford Health System; Detroit Michigan U.S.A
| | - Greg G. Wolff
- Department of Public Health Sciences; Henry Ford Health System; Detroit Michigan U.S.A
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Abstract
Both patients and providers hope for better management strategies for nonspecific activity-related upper limb pain (herein referred to as "arm ache"). The next innovation in the care of arm ache may arise from the strong evidence that mood, coping strategies (e.g., catastrophic thinking), and heightened illness concern-all very responsive to treatment with cognitive behavioral therapy-account for a large percentage of the variation in symptom intensity and magnitude of disability. This focus on treatments to reduce symptoms and disability represents a change in culture for patients and providers, both of whom are accustomed to the biomedical framework that anticipates a direct correspondence between illness (the state of being unwell) and disease (pathophysiology). Not all patients are ready for such an approach, but as a first step health providers can prioritize empathy; remain mindful that words, illness concepts, and treatments can reinforce ineffective coping strategies; and encourage curiosity about the human illness experience.
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