Repression predicts outcome following multidisciplinary treatment of chronic pain.

This study examined whether repression predicts outcome following multidisciplinary treatment for chronic pain and whether links between anxiety and outcome are obscured by repressors. Ninety-three chronic pain patients completed a 4-week pain program. Lifting capacity, walking endurance, depression, pain severity, and activity were measured at pre- and posttreatment. Low-anxious, repressor, high-anxious, and defensive/high-anxious groups were formed from median splits of Anxiety Content (ACS) and Lie scales of the Minnesota Multiphasic Personality Inventory–2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Significant ACS?×?Lie interactions were found for lifting capacity, depression, and pain severity changes. Planned comparisons showed that both repressors and high-anxious patients performed poorly on lifting capacity; repressors alone recovered poorly on depression and pain severity. Results imply that repression may interfere with the process and outcome of pain programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment.

To examine the associations between changes in cognitions and coping and multidisciplinary pain treatment outcomes, the authors had 141 patients with chronic pain complete measures of adjustment, beliefs, catastrophizing, and coping; in addition, their significant others rated patient physical functioning at pretreatment, posttreatment, and 6- and 12-month follow-ups. Decreases in guarding and resting and in the belief that pain signals damage were associated with decreases in patient disability. Increases in perceived control over pain and decreases in catastrophizing and in the belief that one is disabled were associated with decreases in self-reported patient disability, pain intensity, and depression. The results are consistent with the hypothesis, derived from cognitive-behavioral models of chronic pain, that the outcomes of multidisciplinary pain treatment are associated with changes in patient cognitions and coping responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' preferences for pain treatment modalities in a multidisciplinary pain clinic.

44 male and 74 female patients (aged 22–78 yrs) in a multidisciplinary pain clinic rated their preferences for 9 pain treatment modalities: ice, transcutaneous electronic nerve stimulation (TENS), relaxation, group therapy, social work, physical therapy, massage, heat, and lectures. Relaxation, physical therapy, and ice were most liked; TENS, heat, and social work were least liked. Multiple regression analyses indicated that preference for relaxation was the best predictor of decreased pain ratings, while preference for heat was correlated with increased pain ratings. Liking for physical therapy predicted self-ratings at discharge of positive well-being and minor life disruption. Liking for heat predicted self-ratings of major life disruption and nurses' ratings of pain behavior at discharge. Results suggest that treatment regimens should take into account patients' moods and personality styles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sociodemographic predictors of treatment outcome in chronic non-malignant pain patients. Do patients receiving or applying for disability pension benefit from multidisciplinary pain treatment?

A respiration trial was conducted in 14 adult sows to investigate the energetic effects of a high carbohydrate and a high fat diet over a period of 21 weeks. The basal ration was mainly based on barley and soybean meal and covered 60% of the maintenance requirement for energy. The addition of starch (50% wheat starch, 50% maize starch) or fats (25% lard, 25% soybean oil, 50% olive oil) was 173 kJ/kgW0.75. All rations were calculated with reference to the initial weight of the sows and remained constant throughout the experiment. The animals were fed twice daily. Feces and urine were collected during the first and last part of the experiment over six days each. Forty eight hour measurements of the gas exchange were recorded five times in the course of the trial. Energy balances were calculated using an indirect calorimetry technique (RQ method) as well as the carbon nitrogen balance technique. All components of the energy balance (feces energy, urine energy, metabolizable energy, energy retention) showed no significant difference between the two treatments. The heat production of the animals was 413 +/- 31 with the starch diet and 412 +/- 36 kJ/kg W0.75 when the fat diet was fed. The mean weekly body weights of both treatment groups coincided in all phases of the experiment. Calculation of nutrient oxidation performed for diets and for animal metabolism revealed that only the carbohydrate balance was achieved, whereas the fat balance showed unrealistic results. The sensitivity of the nutrient balance method to measurement errors of the gas exchange has been discussed. The current results indicate that an equal supply of starch or fat energy acts identically in the long-term on body weight regulation and energy balance when overfeeding is not present.     

Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis.

Changes in maladaptive cognitions may constitute therapeutic processes of multidisciplinary pain programs. A cross-lagged panel design was used to determine whether (a) early-treatment cognitive change predicted late-treatment outcome index change, but not vice versa; and (b) these effects remained significant with depression change controlled. Ninety chronic pain patients, in a 4-week multidisciplinary program, completed measures of catastrophizing, pain helplessness, depression, pain, interference, and activity level at pre-, mid-, and posttreatment. With depression changes controlled, early-treatment catastrophizing and pain helplessness changes predicted late-treatment outcome index changes, but not vice versa; early-treatment depression changes predicted late-treatment activity changes, but not vice versa. Findings advance understanding of pain treatment process and suggest that negative cognition changes may indeed affect improvements in treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current principles of multidisciplinary treatment of pain in orthopedic clinics

Differentiated strategy of treating patients with acute and chronic pain is developed. Preemptive analgesia is a priority trend in the treatment of acute postoperative pain. The most prevalent method of postoperative analgesia is prolonged opioid epidural analgesia carried out in intensive care wards and other wards by an acute pain management team. For treating patients with chronic painful syndromes, protocols of initial clinical and diagnostic evaluation are developed, permitting the choice of individual treatment strategy. Differentiated complex drug therapy planned with consideration for individual course of the painful syndrome is the basis of treating patients with phantom pain syndrome. Algorithms of differentiated therapy of radicular and spondylogenic pain are designed. Stage-by-stage analysis of treatment efficacy is carried out using modern electrophysiological methods. Realization of the proposed organization principles improved the efficacy of postoperative analgesia to 88.2%, prevented the development of postoperative painful syndrome in 35.6% cases, decreased the incidence of phantom pain syndrome after amputation of the limb from 63.3 to 31.6% and increased the efficacy of this syndrome treatment to 70.1%, and increased the efficacy of treating vertebrogenic painful syndromes to 82.3%.     

Correlates of pain interference in multiple sclerosis.

Objectives: To describe pain interference and explore its associations with several indexes of health and psychosocial functioning among veterans with multiple sclerosis (MS). Study Design: Cohort study linking computerized medical records and survey questionnaire. Participants: Four hundred fifty-one veterans with MS. Outcome Measures: Pain Effects Scale, Patient Health Questionnaire, Modified Social Support Survey, items from the Short Form Health Survey and the North American Research Consortium on MS Registry Survey (NARCOMS) Performance Scales. Results: Participants reported a moderate level of overall pain interference. Increased fatigue, poorer general health, and greater depression symptom severity each were significantly associated with higher levels of pain interference. Conclusions: Pain interference in MS is associated with a variety of other clinically meaningful indexes of functioning. Pain in MS should be treated aggressively to minimize functional impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychophysiologic treatment of chronic lower back pain.

Research concerning the mechanisms and efficacy of psychophysiological treatments for chronic low back pain is reviewed. Despite methodological shortcomings, the literature supports the efficacy of a number of psychophysiological treatments. The mechanism of successful treatment is poorly understood. New models of pathophysiology of muscle pain are presented, and it is hoped that they will clarify treatment issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dropout from treatment for chronic low-back pain.

Chronic low-back pain is a common clinical complaint, and patient dropout can be a major complication to treatment. The authors examined the variables predicting dropout from a 12-week outpatient clinical trial on the treatment of chronic low-back pain. Findings underscore the importance of carefully evaluating the patient's pain severity, attitudes about pain symptoms, and expectations and goals for treatment. Attempts should be made to correct misconceptions and unrealistic expectations regarding the nature of the pain condition, treatment options, likely outcomes, the role of self-regulation training, and family support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in pain perception after treatment for chronic pain

Pain threshold, sensitivity, response bias and ability to discriminate were measured before and after treatment for 15 improved and 15 unimproved chronic pain patients diagnosed as having myofascial pain dysfunction (MPD) syndrome, There were no differences between the groups before treatment. After treatment, the improved group showed an increase in pain threshold, sensitivity and ability to discriminate between different levels of painful stimulation and a decrease in response bias to report pain. The unimproved group showed no changes.     

Opioids in treatment of chronic noncancer pain

Opioids have been accepted as appropriate analgesic treatment for pain associated with cancer. However, controversy exists about their use for chronic noncancer pain. Reasons for reluctance are concerned about efficacy and potential adverse effects such as respiratory depression, addiction, physical dependence or intolerance. Many physicians worry about liability and legal restrictions. Nevertheless, pain management of chronic severe pain with opioids can be the only help when alternative methods are too risky of fail to be effective. This article briefly reviews the published literature on this topic and discusses some practical guidelines for the use of opioids in the treatment of non-cancer pain.     

The use of psychomotor therapy in the treatment of chronic pain.

Describes some psychological and lifestyle characteristics of persons in chronic pain and presents a therapeutic approach—psychomotor therapy— that may be a promising treatment for chronic pain patients. All patients at the Boston Pain Center, a 21-bed, 4-wk inpatient treatment program, participate in psychomotor therapy groups. The therapeutic method is one of focusing on here-and-now feelings and helping the experiencer to find expression and symbolic interactive resolution. Rigid, denial-based defenses are modified in this process. Two case studies are included. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intracerebral neurosurgery in the treatment of chronic pain

Brain surgery is generally considered a treatment of last resort for chronic pain resistant to all other therapeutic measures. The neurosurgical treatment of pain may be either destructive (e.g., thalamotomy) or augmentative (e.g., electrical stimulation through an electrode connected to an implanted neurologic pacemaker). For pain of the neurogenic type (neuropathic or deafferentation pain), the preferred target is either the sensory nucleus of the thalamus, at a site corresponding somatotopically to the location of the pain, or the precentral cortex. For somatic (nociceptive) pain, stimulation of the periventricular or periaqueductal gray matter, or intraventricular infusion of morphine, may be useful. These operations are now indicated only in exceptional cases, as will be explained with reference to the author's long experience.     

Multidisciplinary treatment of chronic low back pain: A review.

Presents an overview of the general theoretical viewpoint of a multidisciplinary treatment of chronic low-back pain. Results from a number of multidisciplinary pain clinics are summarized, and major treatment modalities utilized by this approach are critically reviewed. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment of insomnia secondary to chronic pain.

Sixty participants with insomnia secondary to chronic pain were assigned randomly to either a cognitive–behavioral therapy (CBT) or a self-monitoring/waiting-list control condition. The therapy consisted of a multicomponent 7-week group intervention aimed at promoting good sleep habits, teaching relaxation skills, and changing negative thoughts about sleep. Treated participants were significantly more improved than control participants on self-report measures of sleep onset latency, wake time after sleep onset, sleep efficiency, and sleep quality, and they showed less motor activity in ambulatory recordings of nocturnal movement. At a 3-month follow-up assessment, treated participants showed good maintenance of most therapeutic gains. These results provide the 1st evidence from a randomized controlled trial that CBT is an effective treatment for insomnia that is secondary to chronically painful medical conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of psychologists in multidisciplinary pain clinics: A national survey.

Investigated the roles and responsibilities of psychologists functioning in multidisciplinary pain clinics by surveying 116 comprehensive pain centers throughout the US. 76 surveys (65.5%) were returned that contained analyzable data. Results indicate the following: (a) Psychologists divide their time approximately equally among therapy, evaluation, and other roles; (b) the majority of all pain clinic patients are seen by the psychologist on the team; and (c) behaviorally oriented models of intervention are used most often by the psychologist. Nearly all of the psychologists used clinical interviews in evaluation, along with the Minnesota Multiphasic Personality Inventory (MMPI). Pain questionnaires, especially the Beck Depression Inventory, were also frequently used evaluative devices. Results suggest that needed skills include psychotherapy, assessment, and application of learning theory to the understanding of pain. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sense of coherence as a predictor of work reentry following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain.

This study investigated the association between sense of coherence (SOC) and work reentry. One hundred and fifty-three patients with musculoskeletal pain (mean age=45.6 years, SD=9.1) were included. SOC, demographics, personal characteristics, work status, pain intensity, pain experience, anxiety, and depression were collected during a 57-week rehabilitation period. SOC significantly improved, and pain experience, anxiety, and depression significantly decreased during the rehabilitation period. SOC was found to significantly predict anxiety and depression in the nonwork reentry subsample (n=44). No significant association was found between SOC and work reentry. These data clarify the role of SOC in chronic pain and emotional distress and question the role of SOC in predicting work reentry in long-term chronic musculoskeletal pain conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcosynthesis in the treatment of posttraumatic chronic pain: A case study.

Presents the case history of a 49-yr-old White male with chronic traumatically induced pain complaints who was treated with narcosynthesis. Narcosynthesis was indicated because of the lack of initial success with behavioral treatment strategies, such as psychodrama-assisted implosion techniques and hypnosis-assisted desensitization. The use of sodium-amytal-assisted psychotherapy in the treatment of the condition proved singularly efficacious in the short term. In this therapy, the S was administered iv sodium amytal to induce narcosis and then regressed back by the therapist to the day of the industrial accident that had injured him. Repetition of emotionally laden material allowed the anxiety to subside. Upon awakening, all symptoms were absent. However, the symptoms began to worsen 3 mo later when the S found out that he would be returning to the same work. The role of narcosynthesis in the treatment of traumatically induced chronic pain is discussed, with special reference to a behavioral interpretation of the results obtained. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

有氧运动对治疗慢性下背痛的疗效

目的:探索有氧运动对治疗慢性下背痛疗效的影响.方法:选择社区医疗服务中心40例病史3个月以上的下背痛患者,采用电脑随机方法将受试者分为两组:一组为实验组,进行有氧训练;另一组为对照组,不接受任何训练计划.对照组和实验组分别在干预介入前与介入后进行下背痛失能程度量表和疼痛评分(Visual Analogue Scale,VAS).结果:治疗12周后,发现实验组在治疗后欧式下背痛失能程度显著小于对照组,且VAS评分结果显著优于对照组.结论:有氧运动可以改善慢性下腰痛患者的疼痛程度及改善其失能状况.