Perceived injustice: a historical and clinical review of a useful concept for psychiatry.

OBJECTIVE: Perceived injustice, a concept that arose in pain medicine, refers to an individual's experiences and perceptions of victimisation from injuries resulting in chronic pain. Here, we have undertaken a historical and clinical review on the role of perceived injustice medicine in psychiatry and a systematic review on psychotherapeutic interventions for perceived injustice. METHOD: For the systematic review, two studies were identified from a search of six databases. RESULTS: Though evidence is limited, psychotherapeutic interventions show promise in addressing perceived injustice and associated symptomatology. CONCLUSION: Perceived injustice is a concept which may have great potential utility to psychiatry, particularly in occupational and medicolegal areas. Interventions addressing perceived injustice may help improve clinical outcomes.

Guided Self-Help for People with Chronic Pain: Integrated Care in a Public Tertiary Pain Clinic-A Pilot Study.

INTRODUCTION: Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and health care utilisation. Access to timely, person-centred, cost-effective programs is unattainable for most. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Caring and supporting people with chronic pain involves a range of interventions that incorporate a multifaceted bio-psychosocial approach. Tertiary and primary chronic pain services are optimally placed to deliver integrated models of care. This pilot study explored the effectiveness of an integrated Guided Self-Help (GSH) program within a multidisciplinary tertiary pain unit in a public hospital in Australia. METHODS: A service delivery evaluation was undertaken and a pilot study implemented to determine feasibility and useability of an integrated GSH program for people with chronic pain. A single-group pre-post evaluation was provided to a convenience sample of 42 people referred to the Flinders Medical Centre Pain Management Unit (FMC PMU). Delivered via telehealth or in person by postgraduate students, a manualised GSH workbook was utilised to support adherence and fidelity. Content included goal setting, pain conceptualisation, psychoeducation, activity scheduling, pacing and cognitive strategies. The purpose of the integrated GSH pilot program was to support participants in gaining increased pain literacy, knowledge of effective physical and psychological strategies and enhance self-management of their chronic pain. Levels of psychological distress (PHQ-9 and GAD-7), pain catastrophising (PCS), and pain severity/interference (BPI) were assessed at the beginning and end of support. Integrating the program within a multidisciplinary pain unit intended to facilitate and provide participants with an understanding of their pain through a psychosocial lens, build self-efficacy, and recognise the benefits of other non-medical supports to manage their chronic pain in the future. Outcome data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity - specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390). RESULTS: Participants showed statistically significant improvements on the PHQ-9 [i.e., mean drop of 2.85 (t = 3.16)], GAD [mean drop of 2.52 (t = 2.71)], and PCS [mean drop of 7.77 (t = 3.47)] with small-to-moderate effect sizes. BPI scores did not change. Results were similar when stratifying analyses by those who completed 2-5 versus 6-12 sessions. CONCLUSION: Integrating a GSH program for people with chronic pain into a multidisciplinary tertiary pain clinic is an efficacious and scalable way to increase access to effective strategies that can increase self-efficacy and self-management. Novel, scalable, and effective solutions are needed to improve quality of life and address disparities for people with chronic pain. The psychological shifts and benefits observed support efficacy towards self-management strategies that can increase autonomy and quality of life.

Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and healthcare use. Access to available, effective, and individualised programs is unattainable . People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Scalable solutions are needed to increase access to effective, evidence-based care options and reduce inequities for people with chronic pain. Caring and supporting people with chronic pain requires effective, multifaceted bio-psychosocial approaches that are tailored to individual needs. Using 'coaches', a manualised Guided Self-Help (GSH) program was integrated within a multidisciplinary tertiary pain unit in a public hospital in Australia, which showed promising solutions to increasing access and availability of timely, cost-effective supports that can be delivered via mobile devices. This pilot study explored the effectiveness of offering a GSH program to people with chronic pain integrated into a hospital-based, public, pain management unit to see if it increased people's understanding of their pain and strategies that would support self-management. Coaches working in multidisciplinary teams can support people with information and strategies for their chronic pain, which can free up higher-trained health and medical professionals to care for people with greater complexity and ensure that timely access to support is received by matching need to level and type of support.

Brief introductory group education programs for chronic disease patients in chronic disease management: a scoping review protocol.

OBJECTIVE: This review will scope the literature and map the features of brief introductory group education programs implemented in chronic disease management. INTRODUCTION: Brief introductory group education programs are resource-efficient interventions used in chronic disease management to educate patients about basic disease concepts, self-management strategies, and to introduce specialist services. There is a lack of published research that synthesizes the characteristics, guiding principles, and outcomes reported in brief group education programs in chronic disease management. This scoping review will seek to identify brief introductory group education programs and describe the i) scope of literature available on such programs, ii) characteristics of the programs, iii) guiding self-management principles used and the extent to which programs follow such principles, and iv) types of outcomes reported. INCLUSION CRITERIA: This review will consider studies describing an introductory or brief group patient education program (one to four sessions, no more than eight hours) for the management of chronic disease in adults with ongoing chronic disease. METHODS: MEDLINE, Scopus, CINAHL, Emcare, Web of Science, and PsycINFO will be searched for English-language articles published from 2001 to the present. Titles and abstracts will be screened against inclusion/exclusion criteria, followed by full-text review, independently assessed by two reviewers. Eligible articles will be extracted and charted using a standardized data extraction form. A descriptive review to summarize and contextualize the extracted data will be conducted.

Cumulative glucocorticoid exposure in patients receiving epidural steroid injections: A single-centre retrospective evaluation on 581 procedures against existing clinical recommendations.

Background: The purpose of the study was to review the cumulative corticosteroid doses received from epidural and non-epidural-based pain interventions in a cohort of patients undergoing epidural steroid injections (ESIs) with comparison to safe dosing recommendations. Methods: Retrospective analysis was undertaken for all 349 patients who underwent a total of 581 ESIs at a single-centre, tertiary hospital in South Australia between 2017 and 2019. The primary outcome was the yearly dose analysis of cumulative steroid doses in methylprednisolone equivalents (MDPE) administered from epidural and non-epidural interventions in post-menopausal women, interpreted against maximum recommended doses. Results: The annual limit of 200 â€‹mg for postmenopausal women was exceeded in 4.7% of the time (11/235) from ESIs alone, with a significant rise to 15.3% (46/300) when non-ESI injections were included in cumulative dose totals(p â€‹< â€‹0.001). Of the 173 participants of post-menopausal female age, 4.1% (7/173) received cumulative corticosteroid doses above the 3-year 400 â€‹mg MPDE limit from ESIs alone, with a statistically significant increase to 13.9% (24/173) when non-epidural steroid injections were again included in cumulative dose totals (p â€‹< â€‹0.001). The mean â€‹± â€‹standard deviation administered MPDE per epidural steroid injection across the whole study cohort was 72 â€‹± â€‹22 â€‹mg, nearly double the recommended dose of 40 â€‹mg. Conclusions: Our study underpins the need for vigilance when considering steroid-based pain interventions, wherein both the individual and cumulative steroid exposure should be considered.

Survey of depot antipsychotic prescribing in southern Adelaide.

OBJECTIVE: Depot antipsychotic medication (DAP) is widely used in the treatment of schizophrenia and related disorders. The objectives of this study were to (i) determine whether DAP was being prescribed in accordance with established guidelines in terms of dose, interval of administration and indications; and (ii) assess the quality of the assessment and documentation of tardive dyskinesia (TD) as well as blood glucose and lipid abnormalities. METHODS: The survey was carried out between April and June 2003 at all three public hospital affiliated community mental health centres located in the southern region of Adelaide. Data were extracted from three sources: depot prescription charts, community mental health service case notes and hospital case notes. RESULTS: Two hundred and sixty-one patients were receiving DAP. The majority (89%) had a diagnosis of schizophrenia or schizoaffective disorder. The DAP prescribed most frequently was zuclopenthixol decanoate (57%) at a modal dose of 200 mg and a modal administration interval of 2 weeks. Fifty-three per cent of patients had at least one dose reduction during the course of treatment. Four per cent of patients had a case note documented diagnosis of TD. Fifty-seven per cent of patients had at least one blood glucose test in the past year, with nearly half showing high results. Forty-seven per cent of patients had at least one lipid study in the past year, with more than half having high total cholesterol and 22% having high triglycerides. CONCLUSION: The results of this study indicate that DAP is being used mostly for the treatment of schizophrenia and related disorders, which is in agreement with established evidence-based guidelines. The finding of at least one documented attempt at DAP dose reduction or extension of interval of administration in approximately half of the patients receiving DAP is encouraging and may have an impact on reducing the likelihood of TD. A formal TD surveillance programme using a screening tool such as the Abnormal Involuntary Movement Scale is recommended. In addition, more frequent evaluation of blood glucose and lipid levels is needed.