1
|
Pester BD, Yamin JB, Cabrera MJ, Mehta S, Silverman J, Grossestreuer AV, Howard P, Edwards RR, Donnino MW. Change in Pain-Related Anxiety Mediates the Effects of Psychophysiologic Symptom Relief Therapy (PSRT) on Pain Disability for Chronic Back Pain: Secondary Results from a Randomized Controlled Trial. J Pain Res 2023; 16:3871-3880. [PMID: 38026456 PMCID: PMC10655606 DOI: 10.2147/jpr.s416305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Widely used therapeutic approaches, such as cognitive-behavioral and mindfulness-based therapies, can improve pain and functioning in people with chronic back pain, but the magnitude and duration of their effects are limited. Our team developed a novel 12-week program, psychophysiologic symptom relief therapy (PSRT), to substantially reduce or eliminate pain and disability. This study examined whether PSRT helped more patients achieve large-magnitude (≥30%, ≥50%, ≥75%) reductions in back pain-related disability compared to mindfulness-based stress reduction (MBSR) and usual care (UC), and if the beneficial effects of PSRT were explained by reductions in pain-related anxiety following treatment. Patients and Methods Data from a three-armed randomized controlled trial were used (N=35 adults with chronic back pain). Change scores (baseline to 4-, 8-, 13-, and 26-weeks post-enrollment) were computed for back pain disability (RDQ) and pain-related anxiety (PASS-20). Fisher's exact tests and mediation analyses were conducted. Results Compared to MBSR and UC, PSRT helped significantly more patients achieve ≥75% reductions in back pain disability at all timepoints and in pain anxiety at all timepoints except 13-weeks. Change in pain anxiety significantly mediated the relationship between treatment group and change in back pain disability from baseline to 26-weeks. Conclusion PSRT helped more patients achieve substantial reductions in disability than an established treatment (MBSR) and usual care. Findings indicate reduced pain anxiety may be a mechanism by which PSRT confers long-term benefits on disability. Importantly, this work aims to move the field toward more precise and effective treatment for chronic back pain.
Collapse
Affiliation(s)
- Bethany D Pester
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jolin B Yamin
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Maria J Cabrera
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shivani Mehta
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeremy Silverman
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne V Grossestreuer
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Patricia Howard
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael W Donnino
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
2
|
Santoro SL, Baker S, Blake JM, Cabrera MJ, Caughman K, Chung J, Cullen S, Gallagher M, Haugen K, Hoke-Chandler R, Krell K, Maina J, McLuckie D, Merker VL, Michael C, O’Neill K, Peña A, Pless A, Royal D, Slape M, Spinazzi NA, Torres A, Torres CG, Skotko BG. Views on the impact of the COVID-19 pandemic on health in people with Down syndrome from diverse backgrounds. Am J Med Genet A 2023; 191:2045-2056. [PMID: 37264986 PMCID: PMC10524618 DOI: 10.1002/ajmg.a.63233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
Down syndrome (DS) has a unique medical and psychological profile. To date, few studies have asked individuals with DS about their views of health, and fewer have explored the impact of COVID-19 on the health of individuals with DS and their families. We used a mixed methods approach including two studies on the health of individuals with DS and their parents conducted during the COVID-19 pandemic: (1) eight virtual focus groups, comprised of 20 parents and 8 individuals with DS to obtain participants' views of health, and (2) a 20-item questionnaire on health care experience of patients with DS who are African American or come from primarily Spanish-speaking homes. Focus group transcripts were coded using a hybrid inductive/deductive framework and thematically analyzed using the Framework Method. This questionnaire included questions regarding the impact of COVID-19 on caregivers and their loved ones with DS; responses to these questions were summarized using descriptive statistics. Individuals with DS discussed the impact of the COVID-19 pandemic on their physical and social health including masking, online learning, and online communication with friends and family. Parents of individuals with DS discussed how the COVID-19 pandemic negatively impacted their child's physical, social, and mental health, as a result of virtual schooling and decreased socialization. There were unexpected positives of the pandemic such as improved hygiene and eased scheduling with telehealth visits. Caregivers noted COVID-19 impacted their own anxiety, employment, and other domains that have potential ripple effects on the health of their children. The COVID-19 pandemic had a pervasive impact on the mental health and wellness of caregivers as well as the physical, social, and mental health of individuals with DS.
Collapse
Affiliation(s)
- Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Jasmine M. Blake
- Departments of Internal Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria J. Cabrera
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Jeanhee Chung
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA
| | - Sarah Cullen
- Massachusetts Down Syndrome Congress, Burlington, MA
| | | | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Vanessa L. Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Carie Michael
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Kate O’Neill
- LuMind IDSC Down Syndrome Foundation, Burlington, MA
| | - Angeles Peña
- Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert Pless
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Noemi Alice Spinazzi
- Division of Primary Care, Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Donnino M, Howard P, Mehta S, Silverman J, Cabrera MJ, Yamin JB, Balaji L, Berg KM, Heydrick S, Edwards R, Grossestreuer AV. Psychophysiologic Symptom Relief Therapy (PSRT) for Post-acute Sequelae of COVID-19. Mayo Clin Proc Innov Qual Outcomes 2023; 7:S2542-4548(23)00028-0. [PMID: 37361483 PMCID: PMC10196153 DOI: 10.1016/j.mayocpiqo.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To determine if psychophysiologic symptom relief therapy (PSRT) will reduce symptom burden in patients suffering from post-acute sequelae of COVID-19 (PASC) who had mild/moderate acute COVID-19 disease without objective evidence of organ injury. Patients and Methods Twenty-three adults under the age of 60 with PASC for at least 12 weeks following COVID-19 infection were enrolled in an interventional cohort study conducted via virtual platform between May 18, 2021 and August 7, 2022. Participants received PSRT during a 13 week (approximately 44 hour) course. Participants were administered validated questionnaires at baseline and at 4, 8, and 13 weeks. The primary outcome was change in somatic symptoms from baseline, measured using the Somatic Symptom Scale-8 (SSS-8), at 13 weeks. Results The median duration of symptoms prior to joining the study was 267 days (IQR: 144, 460). The mean SSS-8 score of the cohort decreased from baseline by 8.5 (95% CI: 5.7-11.4), 9.4 (95% CI: 6.9-11.9), and 10.9 (95% CI: 8.3-13.5) at 4, 8, and 13 weeks respectively (all p<.001). Participants also experienced statistically significant improvements across other secondary outcomes including changes in dyspnea, fatigue, and pain (all p<.001). Conclusion PSRT may effectively decrease symptom burden in patients suffering from PASC without evidence of organ injury. The study was registered on clinicaltrials.gov (NCT04854772).
Collapse
Affiliation(s)
- Michael Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Patricia Howard
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shivani Mehta
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY
| | - Jeremy Silverman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Maria J. Cabrera
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jolin B. Yamin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Lakshman Balaji
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Katherine M. Berg
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stanley Heydrick
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robert Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, MA
| | | |
Collapse
|
4
|
Pester B, Yamin JB, Cabrera MJ, Mehta S, Silverman J, Grossestreuer AV, Howard P, Edwards RR, Donnino MW. Change In Pain-Related Anxiety Mediates The Effects Of A Promising Mind-Body Intervention On Treatment Outcomes For Chronic Back Pain: Secondary Results From A Randomized Controlled Trial. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
5
|
Cabrera MJ, Haugen K, Krell K, Torres A, Santoro SL. Pre-visit Concerns: What caregivers hope to address at a specialty clinic for Down syndrome. Eur J Med Genet 2022; 65:104550. [PMID: 35750159 DOI: 10.1016/j.ejmg.2022.104550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/20/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Individuals with Down syndrome have an increased prevalence of various medical conditions across the lifespan; multidisciplinary Down syndrome specialty clinics can address these needs. However, the caregiver-perceived purpose of bringing their loved one to a Down syndrome specialty clinic has not been investigated. METHODS Retrospective review of electronic intake forms, completed prior to visits at MGH's Down Syndrome Program, was completed. Caregiver concerns were coded and analyzed by visit type (new patient vs follow-up), age, gender, and race. RESULTS Information from 722 unique patients (53.6% male) across 1,526 visits from 2014 to 2021 were reviewed resulting in 3,762 concerns. Caregivers of children with Down syndrome ages 0-4, and 13-39 reported a top concern of health maintenance which includes establishing patient care and preventative measures. Behavior was the top concern for caregivers of children with Down syndrome ages 5-12. For adults with Down syndrome, ages 40 years or older, neurologic considerations, including regression and dementia, was the top caregiver concern. Across the entire sample, the top three concerns did not vary by gender. CONCLUSION The top concerns of caregivers of individuals with Down syndrome fluctuate across the lifespan. Growing multidisciplinary specialty clinics for Down syndrome may use these findings to ensure that caregivers' concerns are addressed and improve patient experience.
Collapse
Affiliation(s)
- Maria J Cabrera
- Northeastern University, USA; Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie L Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, USA.
| |
Collapse
|