Effects of prenatal mindfulness-based childbirth education on child-bearers' trajectories of distress: a randomized control trial.

BACKGROUND: The perinatal period is a time of immense change, which can be a period of stress and vulnerability for mental health difficulties. Mindfulness-based interventions have shown promise for reducing distress, but further research is needed to identify long-term effects and moderators of mindfulness training in the perinatal period. METHODS: The current study used data from a pilot randomized control trial (RCT) comparing a condensed mindfulness-based childbirth preparation program-the Mind in Labor (MIL)-to treatment as usual (TAU) to examine whether prenatal mindfulness training results in lower distress across the perinatal period, and whether the degree of benefit depends on child-bearers' initial levels of risk (i.e., depression and anxiety symptoms) and protective (i.e., mindfulness) characteristics. Child-bearers (N = 30) in their third trimester were randomized to MIL or TAU and completed assessments of distress-perceived stress, anxiety, and depressive symptoms-at pre-intervention, post-intervention, six-weeks post-birth, and one-year postpartum. RESULTS: Multilevel modeling of distress trajectories revealed greater decreases from pre-intervention to 12-months postpartum for those in MIL compared to TAU, especially among child-bearers who were higher in anxiety and/or lower in dispositional mindfulness at baseline. CONCLUSIONS: The current study offers preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based program and suggests further investigation of these effects in larger samples is warranted. TRIAL REGISTRATION: The ClinicalTrials.gov identifier for the study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

The Role of Pain Catastrophizing and Depression in the Outcomes of Physical Therapy in a Prospective Osteoarthritis Cohort.

BACKGROUND: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients' response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression. OBJECTIVES: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA. STUDY DESIGN: This research used a prospective, cohort, observational study design. SETTING: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey. METHODS: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression Inventory-II (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes. RESULTS: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome. LIMITATIONS: This study is limited owing to the combined use of several physical therapy modalities and short follow-up. CONCLUSIONS: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy. KEY WORDS: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.

The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain.

BACKGROUND: Psychological variables, including catastrophic thoughts and kinesiophobia, are common in people with chronic musculoskeletal pain and are associated with pain and function. However, the role of each factor has not been evaluated in people with plantar heel pain (plantar fasciitis). METHODS: Thirty-six participants diagnosed with plantar heel pain were recruited. Main outcome measures included the Pain Catastrophising Scale, Tampa Scale of Kinesiophobia, the Foot Health Status Questionnaire and a Visual Analogue Scale. Hierarchical regression models were developed to evaluate the association between each psychological variable with variations in foot pain, first step pain and foot function. RESULTS: In a full model with age, sex and BMI, kinesiophobia contributed to 21% of the variability in foot function and was a significant predictor in this model (Beta=-0.49, P=0.006). In a separate model, catastrophising explained 39% of the variability in foot function and was a significant predictor in this model (Beta=-0.65, P<0.001). Finally, pain catastrophising accounted for 18% of the variability in first step pain and was a significant predictor in a model that also included age, sex and BMI (Beta=0.44, P=0.008). CONCLUSIONS: After controlling for age, sex and BMI, kinesiophobia and catastrophising were significantly associated with foot function, while catastrophising was associated with first step pain in people with plantar heel pain. In addition to addressing biological factors in the management of plantar heel pain, clinicians should consider the potential role of pain catastrophising and kinesiophobia in this population.

Does pain-catastrophising mediate the effect of tai chi on treatment outcomes for people with low back pain?

OBJECTIVES: There is evidence to support the effectiveness of tai chi for reducing pain-related symptoms across multiple musculoskeletal conditions, however, the mechanism(s) are unclear. This study explores the role of pain-catastrophising as a possible mediator in the relationship between practising tai chi and back pain symptoms. DESIGN: Exploratory mediation analyses using a Baron and Kenny approach and bootstrapping methods were employed as a secondary analysis of data from a previously published randomised controlled trial. SETTING: Adults with persistent low back pain were recruited via community advertisement in Sydney, NSW, Australia. INTERVENTIONS: A 10-week tai chi intervention and a wait-list control. MAIN OUTCOME MEASURES: Patients completed self-assessments of pain intensity and bothersomeness using 0-10 numerical rating scales, disability using the Roland Morris Disability Questionnaire and pain catastrophising using the Pain Coping Strategies Questionnaire pre and post intervention. RESULTS: The results suggest partial mediation, by which a reduction in catastrophising explained approximately 1/3 of the effect on pain intensity and bothersomeness and 2/3 of the effect on disability. CONCLUSION: As the first known mediation analysis of tai chi for reducing low back pain-symptoms, it provides initial evidence that it may do so by having an effect on cognitive appraisal outcomes such as pain-catastrophising and information for choosing appropriate process measures for future studies. As tai chi is growing in popularity as an alternative treatment for patients with chronic musculoskeletal conditions, it is important to gain a better understanding of how it might work using confirmatory mediation analysis alongside future RCTs.

Comparison of pain, functioning, coping, and psychological distress in patients with chronic low back pain evaluated for spinal cord stimulator implant or behavioral pain management.

OBJECTIVE: Subgroups of patients with chronic low back pain may exhibit differences in self-reported measures of pain, functioning, coping, and psychological distress. The present study compared subgroups of patients with chronic low back pain referred either for pre-spinal cord stimulator (SCS) psychological evaluations or for behavioral pain management (BPM). DESIGN: Measures from comprehensive pain, functioning, and psychological assessments were compared using multivariate ancova. SETTING: Tertiary care medical outpatient pain management center. SUBJECTS: One hundred and two patients (64% female, mean age = 53.7, standard deviation = 14.3) with chronic low back pain diagnoses were evaluated either as possible candidates for SCS (N = 73) or as part of treatment planning for BPM (N = 29). METHODS: These groups were compared on measures of pain, interference, disability, pain-related anxiety, pain coping, pain catastrophizing, depression, post-traumatic stress symptoms, affective distress, and interpersonal distress assessed using standardized scales. It was hypothesized that the two groups would report similar levels of pain, functioning, and coping, but pre-SCS patients would report fewer psychological symptoms of psychological distress compared with BPM patients in order to gain approval for SCS. RESULTS: Consistent with hypotheses, BPM and pre-SCS patients reported similar pain, functioning, and coping, but pre-SCS patients reported fewer psychological symptoms. CONCLUSIONS: Pre-SCS patients possibly underreport psychological symptoms perhaps to gain SCS approval for SCS. Separate norms and cutoffs for pre-SCS psychological evaluations may be needed to better identify risks of unsuccessful outcomes. Validity scales for measures of psychological distress also could be developed to detect biased reporting. Alternatively, referring clinicians may have referred patients for BPM who were more psychologically distressed and perceived as more in need of psychosocial intervention than those referred for pre-SCS evaluations. Further investigation of clinical referral decisions and assessment bias is warranted to clarify the meaning of these differences and how they apply to patient outcomes.