Accessing care within team-based models of primary care for the management of chronic low back pain in Ontario, Canada: a qualitative study of patient experiences.

PURPOSE: To understand experiences accessing care within team-based primary care models among adults with chronic low back pain (LBP). MATERIALS & METHODS: We conducted an interpretive description qualitative study and collected data using one-to-one semi-structured interviews. Participants were recruited from publicly funded, team-based primary care models in Ontario, Canada. RESULTS: We completed interviews with 16 adults with chronic LBP (9 women; median age of 66). Participants expressed a desire to access care from team-based models of primary care in hopes of alleviating pain and its impacts on daily life. Due to no direct out-of-pocket costs, co-location of healthcare providers, and the use of technology and virtual care, participants described an ease of accessing interprofessional care within team-based primary care models. Finally, participants described experiences with and expectations for timely access to care, being heard and understood by healthcare providers, and receiving coordinated care by an interprofessional team. CONCLUSIONS: Adults living with chronic LBP described overall positive experiences and specific expectations when accessing care within team-based models of primary care, whereby they experienced an ease of accessing interprofessional care with the hope of alleviating pain and its impacts. Results may be transferable to other chronic pain conditions and health system contexts.

Chronic low back pain is a prevalent and disabling health condition that requires comprehensive interprofessional care.Team-based models of primary care may provide an important avenue for patients to access recommended healthcare services, including rehabilitation, for the management of chronic low back pain.Participants in this research described an overall ease of accessing interprofessional care within team-based primary care models with the hope of alleviating pain and its impacts on daily life.Participants described experiences with and expectations for quality care, including timely access to care, being heard and understood by healthcare providers, and receiving a coordinated care plan by an interprofessional team.

The Impact of Inflammatory Bowel Disease on Intimacy: A Multimethod Examination of Patients' Sexual Lives and Associated Healthcare Experiences.

BACKGROUND: Inflammatory bowel disease (IBD) can negatively impact sexual well-being, and some patients desire healthcare for these issues. Research capturing the lived experiences of patients in these areas is lacking. The present study investigated the sexual well-being impacts of IBD (objective 1) and patients' experiences accessing support for these concerns in the healthcare system (objective 2) through multimethod analyses. METHODS: A total of 480 adults with IBD were recruited for an online survey study. Reflexive thematic analysis was used to analyze responses to 2 open-ended questions (ie, qualitative data; question 1, n = 326, question 2, n = 309). Frequency analyses and contingency tables were used to analyze quantitative data (n = 436). RESULTS: Thematic analysis (objective 1) generated 8 themes highlighting the negative impacts of IBD on patients' sexual/intimate lives (eg, sexual activity, intimate relationships) and the influence of broader psychosocial experiences (eg, self-perception, mental health) on patients' sexual well-being. Quantitative analyses (objective 2) indicated that 39.2% of participants wanted sexual health information from a healthcare provider, but only 5.7% of our sample reported both wanting and receiving this information. Thematic analysis generated 5 themes highlighting the lack of support and information available for sexuality concerns in IBD healthcare and detailed patients' perceived barriers to obtaining support in this area. CONCLUSIONS: IBD has myriad impacts on patients' sexual lives. However, patients who want healthcare in this area rarely receive satisfactory support.

Pain Catastrophizing: Controversies, Misconceptions and Future Directions.

Recent reports have pointed to problems with the term "pain catastrophizing." Critiques of the term pain catastrophizing have come from several sources including individuals with chronic pain, advocates for individuals with chronic pain, and pain scholars. Reports indicate that the term has been used to dismiss the medical basis of pain complaints, to question the authenticity of pain complaints, and to blame individuals with pain for their pain condition. In this paper, we advance the position that the problems prompting calls to rename the construct of pain catastrophizing have little to do with the term, and as such, changing the term will do little to solve these problems. We argue that continued calls for changing or deleting the term pain catastrophizing will only divert attention away from some fundamental flaws in how individuals with pain conditions are assessed and treated. Some of these fundamental flaws have their roots in the inadequate training of health and allied health professionals in evidence-based models of pain, in the use of psychological assessment and intervention tools for the clinical management of pain, and in gender equity and antiracism. Critiques that pain scholars have leveled against the defining, operational, and conceptual bases of pain catastrophizing are also addressed. Arguments for reconceptualizing pain catastrophizing as a worry-related construct are discussed. Recommendations are made for remediation of the problems that have contributed to calls to rename the term pain catastrophizing. PERSPECTIVE: The issues prompting calls to rename the construct of pain catastrophizing have their roots in fundamental flaws in how individuals with pain are assessed and treated. Efforts to address these problems will require more than a simple change in terminology.

Differentiating Childhood Traumas in Inflammatory Bowel Disease.

Background: Inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract. Research on inflammatory bowel disease has shown a connection to childhood traumatic events. However, few studies have focused on specific types of traumatic experiences and the impact of confiding in others on disease-related outcomes. This comparative, cross-sectional study expected that: (1) patients would report higher prevalence rates of childhood traumas than healthy controls; (2) healthy controls would report fewer and less severe traumatic experiences than patients and less confiding in others compared to patients; (3) childhood trauma severity would be indirectly related to depressive symptoms through resilience and confiding in others would moderate this relationship. Methods: Participants completed an online survey; an inflammatory bowel disease patient group (N = 195, Mage = 40.48, 76.4% female) was compared to a similarly recruited sample of healthy controls (N = 190, Mage = 31.16, 59.5% female). Results: Patients reported a higher prevalence of experiencing sexual traumas (P = .031), major upheavals (i.e., disruptions) (P = .048), and violence (P = .050) than controls. Patients had significantly higher total trauma severity odds ratios (OR 0.89, 95% CI[0.81,0.97]) and significantly lower total confiding in other odds ratios than controls (OR 1.09, 95% CI[1.02,1.16]). Childhood trauma severity was indirectly related to depressive symptoms through resilience, b = .05, SE = 0.09, 95% CI[0.01,0.09]; however, confiding did not moderate this relationship. Conclusions: Patients reported more sexual, disruptive, and violent traumas. Although confiding did not act as a moderator, trauma was related to depressive symptoms through resilience.

Delivering Team-Based Primary Care for the Management of Chronic Low Back Pain: An Interpretive Description Qualitative Study of Healthcare Provider Perspectives.

Background: Chronic low back pain (LBP) is a prevalent and disabling health issue. Team-based models of primary care are ideally positioned to provide comprehensive care for patients with chronic LBP. A better understanding of primary care team perspectives can inform future efforts to improve how team-based care is provided for patients with chronic LBP in this practice setting. Aims: The aim of this study was to understand health care providers' experiences, perceived barriers and facilitators, and recommendations when providing team-based primary care for the management of chronic LBP. Methods: We conducted an interpretive description qualitative study based on focus group discussions with health care providers from team-based primary care settings in Ontario, Canada. Data were analyzed using thematic analysis. Results: We conducted five focus groups with five different primary care teams, including a total of 31 health care providers. We constructed four themes (each with subthemes) related to experiences, perceived barriers and facilitators, and recommendations to providing team-based primary care for the management of chronic LBP, including (1) care pathways and models of service delivery, (2) team processes and organization, (3) team culture and environment, and (4) patient needs and readiness. Conclusions: Primary care teams are implementing diverse care pathways and models of service delivery for the management of patients with chronic LBP, which can be influenced by patient, team, and organizational factors. Results have potential implications for future research and practice innovations to improve how team-based primary care is delivered for patients with chronic LBP.

Contexte: La lombalgie chronique est un probléme de santé répandu et invalidant. Les modéles de soins primaires en équipe sont particuliérement bien placés pour dispenser des soins complets aux patients souffrant de lombalgie chronique. Une meilleure compréhension des perspectives de l'équipe de soins primaires peut éclairer les efforts futurs visant à améliorer la façon dont les soins en équipe sont dispensés aux patients atteints de lombalgie chronique dans ce cadre de pratique.Objectifs: L'objectif de cette étude était de comprendre les expériences des prestataires de soins de santé, les obstacles et les facilitateurs perçus, ainsi que les recommandations pour la prestation de soins primaires en équipe dans le cadre de la prise en charge de la lombalgie chronique.Méthodes: Nous avons mené une étude qualitative de description interprétative basée sur des discussions de groupe avec des prestataires de soins de santé issus de milieux de soins primaires en équipe en Ontario, au Canada. Les données ont été analysées à l'aide d'une analyse thématique.Résultats: Nous avons organisé cinq groupes de discussion avec cinq équipes de soins primaires différentes, auxquels ont participé 31 prestataires de soins de santé. Nous avons construit quatre thémes (chacun avec des sous-thémes) liés aux expériences, aux obstacles et aux facilitateurs perçus, ainsi qu'aux recommandations relatives à la prestation de services primaires en équipe pour la prise en charge de la lombalgie chronique, y compris (1) les parcours de soins et les modéles de prestation de services, (2) les processus et l'organisation de l'équipe, (3) la culture et l'environnement de l'équipe, et (4) les besoins des patients et leur état de préparation.Conclusions: Les équipes de soins primaires mettent en œuvre divers parcours de soins et modéles de prestation de services pour la prise en charge des patients atteints de lombalgie chronique, qui peuvent être influencés par des facteurs liés au patient, à l'équipe et à l'organisation. Les résultats ont des implications potentielles pour la recherche future et les innovations dans la pratique afin d'améliorer la façon dont les soins primaires en équipe sont dispensés aux patients atteints de lombalgie chronique.

Anxiety in adults with asthma during the coronavirus disease 2019 pandemic: a Canadian perspective.

BACKGROUND: Asthma is a chronic airway inflammatory disease that affects millions of Canadians and often contributes to higher levels of anxiety among patients. Since the coronavirus disease 2019 (COVID-19) pandemic was a time of increased anxiety and fear among the Canadian population, it was thought that those with asthma may experience heightened anxiety levels due to uncertain access to care, the potential to misinterpret asthma symptoms for symptoms of COVID-19 (or vice versa), and the concern about being treated differently by those around them when experiencing asthma symptoms. Therefore, this study sought to perform a cross-sectional analysis of the asthma-anxiety relationship in adults with and without asthma in the unique context of the COVID-19 pandemic from a Canadian perspective. METHODS: This study employed the COVID-19 Associated Anxiety in Allergic Rhinitis and Asthma patients Experiencing Symptoms (CAAARES) survey, consisting of COVID-19-specific questions, the Generalized Anxiety Disorder Assessment-7 (GAD-7) and the Asthma Control Questionnaire-6 (ACQ-6). Data collection occurred through the Qualtrics XM platform and data analyses were conducted with the IBM SPSS Statistics 28 software. RESULTS: A total of 741 valid responses were collected (asthma group, n = 244; control group, n = 497). 31.6% and 26.2% of respondents in the asthma and control groups, respectively, met the diagnostic criteria for GAD. There was no significant difference (p = .067) in mean GAD-7 scores between the two groups. A Hierarchal Multiple Regression (HMR) model was developed, and neither asthma status nor ACQ-6 score had a significant predictive effect on the GAD-7 score. There was a statistically significant (p < .001) weak positive correlation (r = .22) between GAD-7 and ACQ-6 scores. In a simple mediation (SMM) model, perceived COVID-19 stress of others was not identified as a significant mediator of the relationship between ACQ-6 and GAD-7 (indirect effect ß = 0.014). CONCLUSION: Our study of a Canadian cohort demonstrates elevated levels of anxiety overall, amongst both asthma and control groups. While AR status was significantly greater in the asthma group, it was not a significant predictive variable of GAD-7 score. Our data suggests that COVID-19-specific factors appear to have a greater contribution to anxiety than asthma status or control.

Psychosocial factors associated with j-pouch surgery for patients with IBD: a scoping review.

BACKGROUND: Ulcerative colitis and Crohn's disease are subtypes of inflammatory bowel disease: a chronic condition of unclear etiology characterized by inflammation of the small and large intestine. Inflammatory bowel disease is managed with diet, medications, and surgeries, with the most common surgery, recommended to ulcerative colitis patients being j-pouch surgery. PURPOSE: To assess the current literature concerning psychosocial factors associated with j-pouch surgery for patients with inflammatory bowel disease. METHODS: A systematic scoping review of the empirical and grey literature was conducted for original research on j-pouch surgery and psychosocial variables. Eight databases were searched: Medline, PsychInfo, CINAHL, EBM Reviews, ProQuest Dissertations and Theses Global, ResearchGate, Prospero, and PrePubMed. RESULTS: Thirty-nine articles were identified. Many studies (n = 18) adopted a case-series design, and none examined psychosocial interventions. The most popular psychosocial variables assessed were quality of life (n = 34) and those associated with sexual health and functioning (n = 9). CONCLUSIONS: Despite being an established surgical procedure, little research has examined the psychosocial implications of j-pouch surgery. As such, clinicians lack a robust understanding of how this procedure affects patients' psychiatric and social status and adaptive abilities. There is a need for high-quality research utilizing validated measures and rigorous design methodologies with control populations.

Asymptomatic surveillance testing for COVID-19 in health care professional students: lessons learned from a low prevalence setting.

The novel coronavirus disease of 2019 (COVID-19) pandemic has severely impacted the training of health care professional students because of concerns of potential asymptomatic transmission to colleagues and vulnerable patients. From May 27th, 2020, to June 23rd 2021; at a time when B.1.1.7 (alpha) and B.1.617.2 (delta) were the dominant circulating variants, PCR testing was conducted on 1,237 nasopharyngeal swabs collected from 454 asymptomatic health care professional students as they returned to their studies from across Canada to Kingston, ON, a low prevalence area during that period for COVID-19. Despite 46.7% of COVID-19 infections occurring in the 18-29 age group in Kingston, severe-acute-respiratory coronavirus-2 was not detected in any of the samples suggesting that negligible asymptomatic infection occurred in this group and that PCR testing in this setting may not be warranted as a screening tool.

The influence of mental toughness and self-regulation on post-season perceptions in varsity athletes.

OBJECTIVE: To investigate whether pre-season self-reported mental toughness and self-regulation strategies predicts post-season stress, mental health, group cohesion, and satisfaction in varsity athletes. PARTICIPANTS: Sixty-seven varsity athletes from a U-Sport Canadian university. METHODS: Athletes completed pre- and post-season measures of mental toughness, emotion regulation, self-control, group cohesion, and satisfaction. Multiple mediation models were employed during analyses. RESULTS: Pre-season emotion regulation was a significant mediator for the relationships between mental toughness and post-season ratings of perceived stress, perceived mental health, and group cohesion. Self-control was not a significant mediator. CONCLUSIONS: Emotion regulation plays a significant role in an athlete's experience of perceived stress, mental health issues, and their ratings of group cohesiveness. Research on student-athlete health may benefit from examining emotion regulation training techniques.

Patient-Reported Pain Distributions in Inflammatory Bowel Disease: Impact on Patient Psychosocial Outcomes.

Inflammatory bowel disease (IBD) is a painful chronic gastrointestinal disease associated with diminished quality of life. No research documents IBD body pain or the associations of pain patterns to outcomes. Objectives were to map patient body pain areas and examine the associations between pain patterns with depression, catastrophizing, pain severity, and quality of life. A cross-sectional survey was collected from consecutive tertiary-care IBD clinic patients ( n = 255). Patients were classified into three pain pattern groups (No Pain; Localized Pain Only; and Widespread Pain) with more than 40% reporting widespread pain. The Localized Pain Only and Widespread Pain groups reported pain in the abdomen, the uterus/testes, vagina/penis, bladder, and pelvis/buttock areas. The body area most often reported was the anterior abdomen for the Localized Pain Only and Widespread Pain groups, with additional endorsement of lower back and anterior thigh and knees for the Widespread Pain group. The pain versus no pain patients reported greater depressive symptoms, catastrophizing, and diminished quality of life. Patients reported a variety of pain patterns during clinic visits. Widespread pain is associated with greatest pain and poorest psychosocial outcomes.

Anxiety in adults with allergic rhinitis during the coronavirus disease 2019 pandemic: A Canadian perspective.

BACKGROUND: Despite the symptom overlap between allergic rhinitis (AR) and coronavirus disease 2019 (COVID-19), pandemic-time anxiety in people with AR remains an area of limited study. OBJECTIVE: To assess the AR-anxiety relationship in the unique context of the COVID-19 pandemic from a Canadian perspective. METHODS: The COVID-19 Associated Anxiety in patients with Asthma and AR Experiencing Symptoms survey was distributed on the "Qualtrics XM" platform, with 835 adult participants responding to the first iteration from April to August 2020. Anxiety was assessed on the Generalized Anxiety Disorder Assessment-7 (GAD-7), and AR burden of disease was assessed on the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). All analyses were conducted using IBM SPSS Statistics 27. RESULTS: High levels of anxiety were found, with 28.0% of the AR group and 27.5% of the control group meeting the diagnostic criteria for generalized anxiety disorder. After controlling for covariates, AR status had no significant predictive effect on GAD-7 in a hierarchal multiple regression model (ΔR2 = .00, P = .69). In the AR subgroup, there were significant positive correlations between anxiety and burden of disease for the total RQLQ score and all 7 domain scores (P < .001 for all), with the non-nose or eye symptom domain having the strongest correlation (r = .63). After controlling for covariates, total RQLQ score had a predictive effect on GAD-7 in a hierarchal multiple regression model (ΔR2 = .049, P < .001). CONCLUSION: High levels of anxiety exist during the COVID-19 pandemic regardless of AR status, indicating the importance of early anxiety screening in all patients. This study also highlights the importance of non-nose or eye symptoms in AR management.

Implementing a new physiotherapist-led primary care model for low back pain: a qualitative study of patient and primary care team perspectives.

BACKGROUND: Low back pain (LBP) is one of the most common reasons for primary care visits and is the leading contributor to years lived with disability worldwide. The purpose of this study was to understand the perspectives of patients and primary care team members related to their experiences with a new physiotherapist-led primary care model for LBP. METHODS: We conducted an interpretive description qualitative study. Data were collected using a combination of semi-structured interviews and focus group discussions and analyzed using thematic analysis. Participants included adults (> 18 years of age) with LBP and primary care team members who participated in a physiotherapist-led primary care model for LBP in Kingston, Ontario, Canada. RESULTS: We conducted 18 semi-structured interviews with patients with LBP (10 women; median age of 52) as well as three focus group discussions with a total of 20 primary care team members representing three teams. Four themes (each with sub-themes) were constructed: 1) enhanced primary care delivery for LBP (improved access and engagement in physiotherapy care, improved communication and care integration between the physiotherapist and primary care team, less inappropriate use of healthcare resources); 2) positive patient experiences and perceived outcomes with the new model of care (physiotherapist built therapeutic alliance, physiotherapist provided comprehensive care, improved confidence in managing LBP, decreased impact of pain on daily life); 3) positive primary care team experiences with the new model of care (physiotherapist fit well within the primary care team, physiotherapist provided expertise on LBP for the primary care team, satisfaction in being able to offer a needed service for patients); and 4) challenges implementing the new model of care (challenges with prompt access to physiotherapy care, challenges making the physiotherapist the first contact for LBP, and opportunities to optimize communication between the physiotherapist and primary care team). CONCLUSIONS: A new physiotherapist-led primary care model for LBP was described by patients and primary care team members as contributing to positive experiences and perceived outcomes for patients, primary care team members, and potentially the health system more broadly. Results suggest that this model of care may be a viable approach to support integrated and guideline adherent management of LBP in primary care settings.

Understanding Perceived Stress in Adolescent Inflammatory Bowel Disease.

Background: Inflammatory bowel disease (IBD) is a chronic and debilitating illness associated with psychosocial comorbidities. Adolescents are vulnerable to the additive stress of managing IBD and navigating developmental milestones. Psychosocial factors, such as catastrophizing, illness stigma, illness uncertainty, and illness-related shame, often contribute to perceived stress in chronic illnesses. However, the combination of these variables on perceived stress in adolescents with IBD has not been examined. Methods: Participants completed a cross-sectional online self-report survey. Model 4 of PROCESS Macro in SPSS was used to test the parallel mediation model of the relationship between disease severity and perceived stress using catastrophizing, stigma, uncertainty, and shame as mediators using 10,000 bootstrap samples. T-tests were run to assess systematic differences in the dependent variable between subjects. Results: One hundred and thirty-one adolescents (Mage = 18.95 years; 100 females) completed the survey. Females had higher stress scores than males (P =0.002), and there were no difference in stress between younger and older participants (P = 0.085), location (P = 0.484), or IBD type (P = 0.515). The total effect of disease stress on perceived stress operating through the mediators was significant, b = 0.168, SE = 0.028, 95% CI [0.112, 0.224]. Helplessness catastrophizing, illness uncertainty, and illness-related shame, but not illness stigma, were equally strong, positive mediators. Conclusions: The present results suggest that helplessness catastrophizing, illness uncertainty, and illness-related shame are central elements to target in stress interventions for adolescents with IBD.

Chronic prostatitis/chronic pelvic pain syndrome-related pain symptoms and their impact on sexual functioning.

INTRODUCTION: The present study sought to examine a new model to evaluate the mechanistic pathways between pain and sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), incorporating cognitive and emotional factors. METHODS: Men with a self-reported diagnosis of CP/CPPS (n=94, 24-69 years, Mage=44.22, standard deviation 11.25) were recruited through social media, support groups, and urology clinics and completed an online questionnaire of demographic, pain, cognitive, psychological, and sexual variables. Descriptive statistics, correlation analysis, and serial mediation analyses assessed variable associations. RESULTS: Almost half of participants reported mild to severe erectile dysfunction (47.4%). Sexual dysfunction was associated with greater pain symptom severity and pain catastrophizing, as well as depressive symptoms (p<0.01 for all). While pain did not independently predict levels of sexual dysfunction, the addition of pain catastrophizing and depressive symptoms into the pathway explained the association between increased pain symptoms and decreased sexual functioning (p<0.01). CONCLUSIONS: Beyond generally poor sexual functioning in the current sample, it appears as if cognitive and emotional factors play a role in the association between pain symptoms and sexual functioning in these men with CP/CPPS. The findings of how pain catastrophizing and depression impact the association of pain severity and decreased sexual functioning is important for improving patient care.

Childhood trauma, depression, resilience and suicide risk in individuals with inflammatory bowel disease.

Despite the prevalence of suicide risk in inflammatory bowel disease populations, research has yet to examine associations between childhood trauma, resilience, depression and suicide risk. In the present online study, 172 participants responded to measures of childhood trauma, resilience, depression and suicide risk. A moderated mediation revealed that resilience does not moderate the associations between childhood trauma, depressive symptoms and suicide risk. However, a serial mediation revealed that childhood trauma is associated with decreased resilience, which is related to higher depressive symptoms, and ultimately higher suicide risk, thus suggesting resilience and depression as significant intervention targets.

Biopsychosocial predictors of suicide risk in patients with interstitial cystitis/bladder pain syndrome.

INTRODUCTION: The impact of interstitial cystitis/bladder pain syndrome (IC/BPS) is prevalent and severe. Studies examining the IC/BPS prevalence and predictors of suicide risk are limited by their lack of theoretically relevant suicide research variables. This research reports suicide risk prevalence and its biopsychosocial predictors for a community IC/BPS sample. METHODS: Self-identified female patients suffering from IC/BPS (n=813; 18-80 years, mean 46.60, standard deviation [SD] 14.10) recruited from online IC/BPS support groups completed measures of demographic, pain, symptoms, and psychosocial variables. Descriptive statistics, correlations, and multivariable logistic regressions examined prevalence, variable associations, and suicide risk prediction. RESULTS: Suicide risk prevalence was 38.1%. Suicide risk was associated with greater odds for exposure to suicide, psychache, hopelessness, and perceived burdensomeness to others. Further, examining suicide risk by levels of pain showed that exposure to suicide and hopelessness were consistent suicide risk predictors across pain levels; psychache for lower levels of pain, depression in moderate levels of pain, and perceived burdensomeness in moderate and severe pain levels. CONCLUSIONS: The high prevalence of suicide risk is alarming and signifies an imperative for recognizing this risk within the IC/BPS population. The identified psychosocial risk factors may be used in refining screening and treatment, and in directing future IC/BPS research.

Are psychological interventions effective in treating functional dyspepsia? A systematic review and meta-analysis.

BACKGROUND AND AIM: Functional dyspepsia (FD) is a common gastrointestinal disorder, characterized primarily by postprandial fullness or early satiety and/or pain in the epigastrium with no endoscopic evidence of disease. Psychological therapies have been adapted to the treatment of disordered gut-brain interaction such as FD. We sought to determine if psychological interventions were efficacious in providing symptom management and improving health-related quality of life in patients suffering from FD. METHODS: Data were sorted that belonged to Embase (1947 to January 2020), PsychINFO (1806 to January 2020), and Ovid MEDLINE (1946 to January 2020). Randomized controlled trials using a psychological intervention in adults meeting relevant diagnostic criteria for FD were included. Data including symptom scores and quality of life measures were extracted. A random-effect model meta-analysis with standardized mean differences was used. RESULTS: Nine randomized controlled trials were identified that met our inclusion criteria. These were small, single-centered studies and used varying psychological therapies. Three studies had a sham treatment arm, leading to a high risk of bias in the remaining studies. All the studies reported beneficial effects of psychological treatment on patient's symptoms, some of which persisted up to 1 year. Psychological intervention was associated with an improvement in global FD symptom scores (standardized differences in means -1.33, 95% confidence interval -1.97 to -0.68). CONCLUSIONS: Despite the limited data, the available evidence suggests that psychological therapy is beneficial in treating patients with FD and should be considered by treating physicians if available and patients are willing. Large well-designed, sham controlled trials are needed for this extremely common disorder.

The chicken or the egg: Longitudinal changes in pain and catastrophizing in women with interstitial cystitis/bladder pain syndrome.

INTRODUCTION: Evidence-based psychological strategies are being used as clinicians look for helpful interventions for patients diagnosed with the enigmatic chronic urological pelvic pain condition of interstitial cystitis/bladder pain syndrome (IC/BPS). Pain and pain catastrophizing are associated with chronic pelvic pain outcomes but the longitudinal role of catastrophizing on patient pain in IC/BPS remains unknown. METHODS: Women with IC/BPS were recruited from tertiary care clinics across North America and completed a battery of questionnaires, including demographics, pain, depression, catastrophizing at baseline, six months, and one year. RESULTS: A total of 226 patients completed baseline questions, 183 completed the six-month survey, and 151 completed the one-year survey. Using a cross-lagged analysis, early changes in pain catastrophizing predicted later changes in pain, but not vice versa. Followup subscale analyses revealed that early changes in magnification predicted later changes in pain, early changes in pain predicted later changes in rumination, and that there was a recursive relationship between changes in helplessness and changes in pain across the study. CONCLUSIONS: Pain catastrophizing should be considered a prime target in psychological treatment for chronic pain in patients with IC/BPS, particularly those thinking styles associated with pain onset and maintenance. Future research should be conducted with constructs such as pain catastrophizing in samples prioritizing diversity of patients with IC/BPS and mechanisms as to how to effectively decrease catastrophizing.

Modelling symptoms to suicide risk in individuals with inflammatory bowel disease.

Given that suicidal behaviour is a pressing concern in inflammatory bowel disease populations, this study sought to model the sequence of variables that lead to its development. Participants (n = 282) completed online self-report questionnaires regarding predictors of suicidal behaviour. A cross-sectional model of the progression from symptoms to suicide risk revealed that biomedical variables were significantly associated with psychosocial predictors of suicidal behaviour, which were significantly related to theory-driven predictors of suicidal behaviour, which were ultimately associated with suicide risk. Evidently, interventions need to target distal predictors of suicidal behaviour to mitigate harmful downstream effects.