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1.
Pain Med ; 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31626301

RESUMO

OBJECTIVES: This study sought to determine if pre- to post-treatment changes in pain-related activity patterns (i.e., overdoing, avoidance, and pacing) were associated with pre- to post-treatment changes in function (i.e., pain interference, psychological function, and physical function) in patients with fibromyalgia syndrome who participated in either an operant learning- or an energy conservation-based training in activity management. METHODS: Sixty-nine patients with fibromyalgia syndrome participated in an activity management treatment (32 in an operant learning group and 37 in an energy conservation group). Outcomes were assessed at pre- and post-treatment, and patients provided demographic information and completed measures assessing pain intensity, pain interference, psychological function, physical function, and pain management activity patterns. Three linear hierarchical regression analyses predicting changes in pain outcomes from changes in pacing, overdoing, and avoidant activity patterns were performed. RESULTS: Changes in pain-related activity patterns made significant contributions to the prediction of changes in patients' function. Specifically: (a) increases in overdoing predicted reductions in pain interference; (b) decreases in avoidance predicted improvements in psychological function; and (c) increases in pacing predicted improvements in physical function. CONCLUSIONS: This study provides support for a role of activity management treatments in improved adjustment to chronic pain. Research is needed to replicate and extend these findings in order to build an empirical basis for developing more effective chronic pain treatments for facilitating improved physical and psychological function in individuals with chronic pain.

2.
BMJ Open ; 9(10): e029542, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31615796

RESUMO

OBJECTIVES: The Scleroderma Patient-centered Intervention Network (SPIN) Cohort uses the cohort multiple randomised controlled trial design to embed trials of online self-care interventions for people living with systemic sclerosis (SSc; scleroderma). To offer interventions to patients interested in using them, participants complete signalling items that query about the likelihood that patients would agree to participate in nine different hypothetical online programmes addressing common SSc-related problems. It is not known what factors influence patient-reported interest in participating in a particular online intervention and if intervention-specific signalling questions provide unique information or replicate broader characteristics, such as overall willingness to participate or self-efficacy. This study assessed factors that explain responses to intervention-specific signalling items. DESIGN: Cross-sectional survey. SETTING: SPIN Cohort participants enrolled at 42 centres from Canada, the USA, the UK, France, Spain and Mexico who completed study questionnaires from March 2014 to January 2018 were included. MEASURES: Demographic and disease characteristics, self-efficacy and symptoms related to each specific intervention were completed in addition to signalling items. General likelihood of using interventions was calculating by taking the mean score of the remaining signalling questions. PARTICIPANTS: 1060 participants with complete baseline data were included in the analyses. RESULTS: For all individual signalling questions, controlling for other variables, the mean of the remaining signalling questions was the strongest predictor (standardised regression coefficient ß from 0.61 (sleep) to 0.80 (self-management)). Smaller, but statistically significant, associations were found with the symptom associated with the respective signalling question and with general self-efficacy for 7 of 9 signalling questions. CONCLUSIONS: The main factor associated with patients' interest in participating in a disease-specific online self-care intervention is their general interest in participating in online interventions. Factors that may influence this general interest should be explored and taken into consideration when inviting patients to try online interventions.

4.
Expert Rev Clin Immunol ; 15(5): 541-552, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30669892

RESUMO

INTRODUCTION: Most arthritides are associated with pain and psychological distress (clinically significant depression and anxiety). Pain and depression are mutually exacerbating; both may continue even when joint involvement appears well controlled. Area covered: There is strong evidence that arthritis-related stress impacts the central nervous system and, together with peripheral inflammatory changes, can cause central sensitization that can lead to chronic pain and worsening of affective distress. Cytokines and chemokines participate both in joint inflammation and in central sensitization. We review evidence of these relationships in five arthritides, namely rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, gout, and in osteoarthritis of the hips and knees. Central sensitization in these conditions results in long-lasting pain and psychological distress. Expert commentary: Chronic pain and depression are important but often neglected in the clinical assessment and treatment of arthritis. The potential role of biologic cytokines and Janus kinase inhibitors in dealing with these symptoms needs further study.

5.
J Pain ; 2018 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-30326271

RESUMO

This study's aim was to assess the efficacy of 2 forms of activity pacing in patients with fibromyalgia syndrome (FMS). Treatment-related changes in activity management patterns were also examined. Patients with FMS (n = 178) were randomly assigned to an operant learning (OL; delayed [n = 36] or immediate [n = 54] groups) or an energy conservation (EC; delayed [n = 35] or immediate [n = 53] groups) treatment condition. Of these, 32 OL and 37 EC patients completed treatment. Forty-three patients were allocated to the delayed treatment condition (control group). Repeated measures analyses of variance were used to examine the effects of OL and EC treatments on primary (average pain and usual fatigue), secondary (pain and fatigue interference, physical and psychological function, sleep quality, depressive symptoms, and anxiety symptoms), and tertiary (pain-related activity patterns) outcomes. Neither treatment was effective in reducing average pain or usual fatigue symptoms. Relative to EC, OL patients showed greater improvements in depressive symptoms, whereas nonsignificant trends (P values ranging between .05 and .06) were observed for pain interference, fatigue interference, and psychological function. Both treatments were associated with improvements in sleep quality and physical function, increases in pacing, and decreases in overdoing activity patterns. Reductions in activity avoidance were only found in OL. These findings suggest that OL may be more beneficial than EC and that it could potentially be viewed as an effective stand-alone activity pacing treatment for patients with FMS. Research to determine the extent to which these preliminary findings replicate is warranted. PERSPECTIVE: This article examines the efficacy of 2 forms of activity pacing in patients with fibromyalgia syndrome. The results suggest the possibility that operant learning may be more beneficial than energy conservation and could potentially be viewed as an effective stand-alone activity pacing treatment for patients with fibromyalgia syndrome.

6.
Pain ; 159(12): 2522-2529, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30074594

RESUMO

Changes in activity patterns frequently accompany the experience of chronic pain. Two activity patterns, avoidance and overdoing, are hypothesized to contribute to the development of ongoing pain and pain-related disability, while activity pacing is frequently introduced to enhance pain management and functioning. Two studies were conducted to assess whether reliable subgroups with differing activity patterns could be identified in different pain populations and to evaluate changes in these subgroups after a group format, pain management program. In study 1, individuals with ongoing pain being assessed for treatment at 2 different tertiary care pain centres completed a measure of pain-related activity. Separate cluster analyses of these samples produced highly similar cluster solutions. For each sample, a 2-cluster solution was obtained with clusters corresponding to the activity patterns described by the avoidance-endurance model of pain. In study 2, a subset of individuals completing a 12-session, group format, pain management program completed measures of pain-related activity, pain intensity, and physical and psychological functioning at the beginning and end of the program. At the conclusion of the program, 4 clusters of pain-related activity were identified. Individuals who used high levels of activity pacing and low levels of avoidance consistently reported significantly better functioning relative to all other individuals. Observed changes in activity patterns from pre-treatment to post-treatment suggested that decreasing the association between activity pacing and avoidance was associated with better functioning. These results have implications for both the assessment of activity pacing and for its use as an intervention in the management of ongoing pain.

7.
Rheumatology (Oxford) ; 57(9): 1623-1631, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29868924

RESUMO

Objectives: The Scleroderma Patient-centered Intervention Network (SPIN) Cohort is a web-based cohort designed to collect patient-reported outcomes at regular intervals as a framework for conducting trials of psychosocial, educational, self-management and rehabilitation interventions for patients with SSc. The aim of this study was to present baseline demographic, medical and patient-reported outcome data of the SPIN Cohort and to compare it with other large SSc cohorts. Methods: Descriptive statistics were used to summarize SPIN Cohort characteristics; these were compared with published data of the European Scleroderma Trials and Research (EUSTAR) and Canadian Scleroderma Research Group (CSRG) cohorts. Results: Demographic, organ involvement and antibody profile data for SPIN (N = 1125) were generally comparable with that of the EUSTAR (N = 7319) and CSRG (N = 1390) cohorts. There was a high proportion of women and White patients in all cohorts, though relative proportions differed. Scl70 antibody frequency was highest in EUSTAR, somewhat lower in SPIN, and lowest in CSRG, consistent with the higher proportion of interstitial lung disease among dcSSc patients in SPIN compared with in CSRG (48.5 vs 40.3%). RNA polymerase III antibody frequency was highest in SPIN and remarkably lower in EUSTAR (21.1 vs 2.4%), in line with the higher prevalence of SSc renal crisis (4.5 vs 2.1%) in SPIN. Conclusion: Although there are some differences, the SPIN Cohort is broadly comparable with other large prevalent SSc cohorts, increasing confidence that insights gained from the SPIN Cohort should be generalizable, although it should be noted that all three cohorts include primarily White participants.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Assistência Centrada no Paciente , Escleroderma Sistêmico/epidemiologia , Canadá/epidemiologia , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/terapia , Índice de Gravidade de Doença , Inquéritos e Questionários , Estados Unidos/epidemiologia
8.
Disabil Rehabil ; : 1-10, 2018 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-29741963

RESUMO

PURPOSE: The purpose of this study was to explore challenges faced by patients with systemic sclerosis, also called scleroderma, in coping with their disease and the strategies they used to face those challenges. METHOD: Five focus groups were held with scleroderma patients (4 groups, n = 34) and health care professionals who have experience treating scleroderma (1 group, n = 8). Participants' discussions were recorded, transcribed and analyzed using thematic analysis. RESULTS: Participants reported challenges accessing information (e.g., knowledgeable specialists), dealing with negative emotions (e.g., stress due to misunderstandings with loved ones), and accessing resources (e.g., helpful products or devices). Strategies for overcoming challenges were also discussed (e.g., advocating for own needs). CONCLUSION: When faced with significant challenges while coping with scleroderma, patients develop strategies to manage better and improve their quality of life. To help them cope, patients would benefit from easier access to supportive interventions, including tailored scleroderma self-management programs. Although the challenges experienced by patients with scleroderma are unique, findings from this study might help better understand patients' perspectives regarding coping and disease management for other chronic diseases as well. Implications for Rehabilitation People living with rare diseases, including the rare autoimmune disease scleroderma, face unique challenges and often do not have access to disease-specific educational or other support resources. People with scleroderma report that they face challenges in accessing information, including knowledgeable healthcare providers; managing difficult social interactions and negative emotions; and accessing resources. Strategies employed by scleroderma patients to overcome these challenges include seeking connections to other people with scleroderma or scleroderma patient organizations, actively seeking out local resources, and learning to communicate and advocate more effectively. Rehabilitation professionals can support people with scleroderma by providing them with information on connecting with scleroderma patient organizations or by facilitating local patient support networks.

9.
Clin J Pain ; 34(2): 122-129, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28591081

RESUMO

OBJECTIVES: To clarify the importance of avoidance, pacing, and overdoing pain-related activity management patterns as predictors of adjustment in patients with fibromyalgia syndrome. METHODS: A total of 119 tertiary care patients with fibromyalgia syndrome who agreed to be part of an activity management pain program completed a survey, which requested information about demographics, pain intensity and pain interference, psychological and physical function, and pain-related activity management patterns. Hierarchical regression analyses were used to identify the unique contributions of the 3 different pain-related activity management patterns (avoidance, pacing, and overdoing) to the prediction of pain interference, psychological function, and physical function. RESULTS: The avoidance pattern was a significant and unique predictor of worse psychological and physical function as well as greater pain interference. Pacing was significantly associated with less pain interference and better psychological function, whereas overdoing was not found to predict patient functioning. DISCUSSION: The findings confirm the importance of pain-related activity management patterns as predictors of patient function, and support the necessity of addressing these factors in chronic pain treatment. In addition, the results suggest that targeting increases in activity pacing and decreases in pain avoidance, specifically, might yield the best patient outcomes. However, further research to evaluate this possibility is necessary.

10.
Front Neuroanat ; 11: 47, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28642688

RESUMO

Fibromyalgia (FM) syndrome is characterized by chronic widespread pain, muscle tenderness and emotional distress. Previous studies found reduced endogenous pain modulation in FM. This deficiency of pain modulation may be related to the attributes of chronic pain and other clinical symptoms experienced in patients with FM. Thus, we tested whether there is a link between the clinical symptoms of FM and functional connectivity (FC) of the periaqueductal gray (PAG), a key node of pain modulation. We acquired resting state 3T functional MRI (rsfMRI) data from 23 female patients with FM and 16 age- and sex- matched healthy controls (HC) and assessed FM symptoms with the Brief Pain Inventory (BPI), Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS) and Pain Catastrophizing Scale (PCS). We found that patients with FM exhibit statistically significant disruptions in PAG FC, particularly with brain regions implicated in negative affect, self-awareness and saliency. Specifically, we found that, compared to HCs, the FM patients had stronger PAG FC with the lingual gyrus and hippocampus but weaker PAG FC with regions associated with motor/executive functions, the salience (SN) and default mode networks (DMN). The attenuated PAG FC was also negatively correlated with FIQ scores, and positively correlated with the magnification subscale of the PCS. These alterations were correlated with emotional and behavioral symptoms of FM. Our study implicates the PAG as a site of dysfunction contributing to the clinical manifestations and pain in FM.

11.
Rheumatology (Oxford) ; 56(8): 1302-1311, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28431140

RESUMO

Objective: The Patient-Reported Outcomes Measurement Information System (PROMIS)-29 assesses seven health-related quality of life domains plus pain intensity. The objective was to examine PROMIS-29v2 validity and explore clinical associations in patients with SSc. Methods: English-speaking SSc patients in the Scleroderma Patient-centered Intervention Network Cohort from 26 sites in Canada, the USA and the UK completed the PROMIS-29v2 between July 2014 and November 2015. Enrolling physicians provided medical data. To examine convergent validity, hypotheses on the direction and magnitude of correlations with legacy measures were tested. For clinical associations, t -tests were conducted for dichotomous variables and PROMIS-29v2 domain scores. Effect sizes (ESs) were labelled as small (<0.25), small to moderate (0.25-0.45), moderate (0.46-0.55), moderate to large (0.56-0.75) and large (>0.75). Results: There were 696 patients (87% female), mean ( s . d .) disease duration 11.6 (8.7) years, 57% with limited cutaneous subtype. Validity indices were consistent with seven of nine hypotheses (| r | =0.51-0.87, P < 0.001), with minor divergence for two hypotheses. Gastrointestinal involvement was associated with significantly worse outcomes for all eight PROMIS-29v2 domains (moderate or moderate to large ES in six of eight). Presence of joint contractures was associated with significant decrements in seven domains (small or small to moderate ESs). Skin thickening, diffuse cutaneous subtype and presence of overlap syndromes were significantly associated (small or small to moderate ESs) with five or six domains. Conclusion: This study further establishes the validity of the PROMIS-29v2 in SSc and underlines the importance of gastrointestinal symptoms and joint contractures in reduced health-related quality of life.


Assuntos
Nível de Saúde , Avaliação de Resultados (Cuidados de Saúde)/métodos , Medidas de Resultados Relatados pelo Paciente , Escleroderma Sistêmico/patologia , Índice de Gravidade de Doença , Adulto , Idoso , Canadá , Estudos de Coortes , Contratura/etiologia , Feminino , Gastroenteropatias/etiologia , Humanos , Artropatias/etiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Reprodutibilidade dos Testes , Escleroderma Sistêmico/complicações , Inquéritos e Questionários , Reino Unido , Estados Unidos
12.
Pain Med ; 18(2): 283-293, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28204732

RESUMO

Objectives: This study's aim was to identify the most important general and pain-related risk factors of suicidal ideation in a large sample of patients with chronic non-cancer pain. Methods: A total of 728 patients with chronic non-cancer pain were recruited from the waitlists of eight multidisciplinary pain clinics across Canada. Patients were assessed using self-administered questionnaires to measure demographic, pain-related (intensity, duration, interference, sleep problems), psychological (anxiety, anger, depressive symptoms including suicidal ideation), cognitive (catastrophizing, attitudes/beliefs), and health-related quality of life variables. A hierarchical logistic regression analysis was used to identify the factors that were associated with presence/absence of suicidal ideation while controlling for depressive symptoms. Results: The results showed that being a male, longer pain duration, higher anger levels, feelings of helplessness, greater pain magnification, and being more depressed were significant independent predictor factors of suicidal ideation, while better perceived mental health was related with a lesser likelihood of suicidal ideation. Moreover, being in a relationship and believing in a medical cure for pain might be protective of suicidal ideation while being anxious may be more associated with suicidal ideation. Conclusions: These results indicate that development of suicidal ideation is more closely related to pain chronicity and certain psychosocial factors than how severe or physically incapacitating the pain is. Many of these factors could potentially be modified by early identification of suicidal ideation and developing targeted cognitive interventions for suicidal at-risk patients. Research to examine the efficacy of these interventions for reducing suicidal ideation is warranted.


Assuntos
Dor Crônica/psicologia , Ideação Suicida , Adulto , Idoso , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Risco , Inquéritos e Questionários
13.
J Pain Symptom Manage ; 52(1): 43-53, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26876159

RESUMO

CONTEXT: Pain and itch are common symptoms reported by patients with systemic sclerosis (SSc; scleroderma), which can markedly diminish function and health-related quality of life (HRQL). OBJECTIVES: The aim of this exploratory study was to examine the impact that pain, itch, and the interaction of both have on function (depressive symptoms, overall disability, fatigue, sleep disturbance) and HRQL in patients with SSc. METHODS: A total of 964 patients from the Canadian Scleroderma Reserch Group Registry completed questionnaires measuring itch and pain severity, function, and HRQL. Multiple regression analyses were performed to examine the impact that pain, itch, and pain × itch interaction have on each outcome variable while controlling for demographic measures. A P-value of ≤0.01 was required for a difference to be deemed statistically significant. RESULTS: Our results revealed that patients with SSc who reported higher pain and itch severity were also more likely to have greater depressive symptoms, overall disability, sleep and fatigue problems, even when demographic measures were controlled for (P-values ≤0.001). Similar results were obtained for HRQL, regardless of the domains (P-values ≤0.001). A significant association between pain × itch interaction and sleep (P = 0.002), physical functioning (P = 0.003), and general health (P ≤ 0.001) variables also was found. Further investigation of the nature of the pain × itch interaction showed that the effect of pain severity on outcome variables diminishes as itch severity increases. CONCLUSION: Both pain and itch appear to have a detrimental impact on functioning and HRQL in patients with SSc, suggesting that more targeted approaches to symptom management are warranted.


Assuntos
Dor/psicologia , Prurido/psicologia , Qualidade de Vida , Escleroderma Sistêmico/psicologia , Idoso , Canadá , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Avaliação da Deficiência , Fadiga/epidemiologia , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/etiologia , Prurido/epidemiologia , Prurido/etiologia , Sistema de Registros , Análise de Regressão , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários
14.
Pain ; 157(9): 1946-1953, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-28146042

RESUMO

Catastrophizing is recognized as a key psychosocial factor associated with pain-related negative outcomes in individuals with chronic pain. Longitudinal studies are needed to better understand the temporal relationship between these constructs. The aim of this study was to determine if changes in catastrophizing early in treatment predicted subsequent changes in pain intensity and interference later in treatment, or alternately, if early changes in pain intensity and interference predicted subsequent changes in catastrophizing. A total of 538 patients with neuropathic pain were recruited from 6 multidisciplinary pain clinics across Canada. Study participants were asked to complete measures of catastrophizing, pain intensity, and interference when first seen in the clinic and then again at 3- and 6-month follow-ups. Cross-lagged panel analyses were used to determine the temporal associations among the study variables. The results showed that decreases in catastrophizing early in treatment prospectively predicted improvement in both pain intensity and interference later in treatment. Converse temporal relationships were also found, where a reduction in pain intensity and interference early in treatment predicted a subsequent diminishing of catastrophizing. All 4 unique cross-lagged correlations significantly accounted for an additional 4% to 7% of the total variance. The findings are consistent with theoretical models hypothesizing a causal impact of catastrophizing on pain, suggesting a mutual causation between these factors. The results support that treatments targeting catastrophizing may influence other pain-related outcomes, and conversely that treatments aiming to reduce pain could potentially influence catastrophizing. There may therefore be multiple paths to positive outcomes.


Assuntos
Catastrofização/psicologia , Neuralgia , Manejo da Dor/métodos , Adulto , Idoso , Canadá , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neuralgia/fisiopatologia , Neuralgia/psicologia , Neuralgia/terapia , Medição da Dor , Escalas de Graduação Psiquiátrica , Análise de Regressão , Inquéritos e Questionários
15.
Arthritis Care Res (Hoboken) ; 68(8): 1195-200, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26619042

RESUMO

OBJECTIVE: Self-management programs for patients with chronic illnesses, including rheumatic diseases, seek to enhance self-efficacy for performing health management behaviors. No measure of self-efficacy has been validated for patients with systemic sclerosis (SSc; scleroderma). The objective of this study was to assess the validity and internal consistency reliability of the Self-Efficacy for Managing Chronic Disease (SEMCD) scale in SSc. METHODS: English-speaking SSc patients enrolled in the Scleroderma Patient-centered Intervention Network Cohort who completed the SEMCD scale at their baseline assessment between March 2014 and June 2015 were included. Patients were enrolled from 21 sites in Canada, the US, and the UK. Confirmatory factor analysis (CFA) was used to evaluate the factor structure of the SEMCD scale. Cronbach's alpha was calculated to assess internal consistency reliability. Hypotheses on the direction and magnitude of Pearson's correlations with psychological and physical outcome measures were formulated and tested to examine convergent validity. RESULTS: A total of 553 patients were included. CFA supported the single-factor structure of the SEMCD scale (Tucker Lewis Index = 0.99, comparative fit index = 0.99, root mean square error of approximation = 0.10). Internal consistency was high (α = 0.93), and correlations with measures of psychological and physical functioning were moderate to large (|r| = 0.48-0.67, P < 0.001), confirming study hypotheses. CONCLUSION: Scores from the SEMCD scale are valid for measuring self-efficacy in patients with SSc, and results support using the scale as an outcome measure to evaluate the effectiveness of self-management programs in SSc.


Assuntos
Psicometria/métodos , Escleroderma Sistêmico/psicologia , Autoeficácia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos de Coortes , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado/métodos , Adulto Jovem
16.
Clin J Pain ; 32(6): 495-505, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26340652

RESUMO

OBJECTIVES: Pain disability is a major impediment to fibromyalgia (FM) patients' quality of life. Neuroimaging studies have demonstrated abnormal pain processing in FM. However, it is not known whether there are brain abnormalities linked to pain disability. Understanding neural correlates of pain disability in FM, independent from pain intensity, could provide a framework to guide future more efficient therapy strategies to improve patients' functional ability. METHODS: We used arterial spin labeling to image cerebral blood flow (CBF) in 23 FM patients and 16 controls. Functional connectivity was also estimated using blood oxygenation level-dependent imaging to further investigate the possible underpinnings of the observed CBF changes. RESULTS: Among patients, CBF in the basal ganglia correlated negatively with pain disability index and positively with the overall impact of FM (Fibromyalgia Impact Questionnaire) but did not correlate with pain intensity. Whole-brain analysis revealed no CBF differences between the 2 groups; however, post hoc analysis in the basal ganglia showed CBF reductions mainly in the right putamen and right lateral globus pallidus in patients, likely reflecting the negative correlation with the pain disability index. However, the connectivity of the corresponding corticobasal ganglia-thalamus loop, that is, motor network (the connection between supplementary motor area, putamen, and thalamus) remained intact. DISCUSSION: Basal ganglia perfusion reflects long-term symptoms, including somatic and psychological components of FM rather than pain intensity. These CBF findings may reflect differences in behavioral and psychological responses between patients.


Assuntos
Gânglios da Base/irrigação sanguínea , Gânglios da Base/diagnóstico por imagem , Fibromialgia/complicações , Fibromialgia/patologia , Dor/etiologia , Imagem de Perfusão , Adulto , Vias Aferentes/irrigação sanguínea , Vias Aferentes/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Análise de Regressão , Marcadores de Spin
17.
Clin J Pain ; 31(5): 425-32, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25329143

RESUMO

OBJECTIVES: To examine whether men and women with fibromyalgia syndrome (FMS) differ with respect to pain severity and functioning, pain-related beliefs, or pain-related coping. We hypothesized no significant sex differences in measures of pain and functioning, but that we would observe differences between men and women in how they view and how they cope with FMS-related pain. METHODS: A total of 747 women and 48 men with FMS who attended a multidisciplinary treatment program completed the study measures. Analyses of covariance were used to examine sex differences in the study measures, with a P-value of ≤0.01 and at least a moderate effect size (Cohen d≥0.5) required for a difference to be deemed statistically significant. RESULTS: Men and women did not differ on demographic measures except for their age, with the men in our sample being significantly younger than the women. Consistent with the study hypothesis, the results revealed no sex differences in the measures of pain and functioning. For pain-related beliefs, men were more likely to view pain as reflecting harm, and they were also more likely than women to use activity avoidance as a pain-coping strategy. DISCUSSION: The study findings suggest that women and men with FMS may think about and cope with pain somewhat differently, and may therefore benefit from different types of psychosocial pain intervention.


Assuntos
Adaptação Psicológica/fisiologia , Fibromialgia/complicações , Dor/etiologia , Dor/psicologia , Caracteres Sexuais , Adulto , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários
18.
J Consult Clin Psychol ; 83(1): 1-11, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24979313

RESUMO

OBJECTIVE: Many studies document efficacy of cognitive behavioral therapy (CBT) for chronic pain, but few studies have examined potential treatment mechanisms. In analyses of data from a controlled trial, we examined whether changes in attitudes toward adopting a pain self-management approach-CBT-specific mechanisms-and quality of working alliance and patient expectations-general mechanisms-early in treatment were related to later-treatment changes in outcomes. METHOD: Our sample was composed of 94 adults (primarily White; mean age: 55.3 years, SD = 11.7; 23% female) who participated in enhanced or standard CBT, and completed measures of attitudes toward self-management (mechanisms), pain intensity, pain interference, depressive symptoms and goal accomplishment (outcomes) at pretreatment, 4- and 8-week assessments, and posttreatment. Working alliance was measured at 4 and 8 weeks, and patient expectations at 3 weeks. RESULTS: Because the CBT conditions produced comparable improvements, we combined them. Precontemplation and action attitudes toward pain self-management showed significant quadratic trends over assessments such that 67% and 94.1% (respectively) of total pre-post changes occurred in the first 4 weeks. Outcomes showed only significant linear trends. Cross-lagged regressions revealed that pretreatment-to-4-week changes in action attitudes and 4-week levels of working alliance were related significantly with 4-week-to-posttreatment changes in pain intensity and interference but not vice versa and that 3-week patient expectations were related to 4-week-to-posttreatment changes in interference. Analyses in which mechanism factors were entered simultaneously revealed nonsignificant unique effects on outcomes. CONCLUSIONS: Adopting an action attitude early in treatment may represent a specific CBT mechanism but with effects held largely in common with 2 general mechanisms.


Assuntos
Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Avaliação de Processos e Resultados (Cuidados de Saúde) , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Clin J Pain ; 31(7): 603-11, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25119513

RESUMO

OBJECTIVE: To examine the relative validity of 2 conceptual models-Specific, General-by which therapeutic mechanisms in cognitive-behavioral therapy (CBT) for chronic pain achieve favorable outcomes. METHODS: As part of a clinical trial of enhanced versus standard CBT, people with chronic pain received treatment consisting of 3 pain coping skill modules. In secondary analyses of a subsample (n=56), we examined pretreatment to session 4 (of 10 sessions) changes in Chronic Pain Coping Inventory subscales that corresponded to receipt of one of 3 modules; namely Relaxation, Exercise, and Cognitive Coping modules. RESULTS: Findings indicated that: (1) participants receiving the Relaxation module improved more than other groups in relaxation skills, and improved substantially on other coping skills, as well; (2) participants receiving Exercise and Cognitive Coping modules showed mixed improvements and did not improve more than other groups on exercise use or cognitive coping, respectively; and (3) measures of patient-therapist working alliance and patient expectations of treatment benefit at session three correlated significantly with some coping skills changes. DISCUSSION: Change with CBT may occur both by theory-specified mechanisms and general mechanisms. However, the results provide the most support for a General Mechanism model in which changes on coping skills have spreading effects on the use of other coping skills. Significant relationships between some skill changes and indexes of patient-therapist working alliance and outcome expectations suggest that nonspecific factors also play a role in treatment-related changes in the use of pain coping strategies.


Assuntos
Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Modelos Psicológicos , Adaptação Psicológica , Dor Crônica/psicologia , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Relações Profissional-Paciente , Relaxamento , Resultado do Tratamento
20.
Pain Res Manag ; 19(6): 293-9, 2014 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25479149

RESUMO

BACKGROUND: Adjudication of disability claims related to fibromyalgia (FM) syndrome can be a challenging and complex process. A commentary published in the current issue of Pain Research & Management makes suggestions for improvement. The authors of the commentary contend that: previously and currently used criteria for the diagnosis of FM are irrelevant to clinical practice; the opinions of family physicians should supersede those of experts; there is little evidence that trauma can cause FM; no formal instruments are necessary to assess disability; and many FM patients on or applying for disability are exaggerating or malingering, and tests of symptoms validity should be used to identify malingerers. OBJECTIVES: To assess the assertions made by Fitzcharles et al. METHODS: A narrative review of the available research literature was performed. RESULTS: Available diagnostic criteria should be used in a medicolegal context; family physicians are frequently uncertain about FM and/or biased; there is considerable evidence that trauma can be a cause of FM; it is essential to use validated instruments to assess functional impairment; and the available tests of physical effort and symptom validity are of uncertain value in identifying malingering in FM. CONCLUSIONS: The available evidence does not support many of the suggestions presented in the commentary. Caution is advised in adopting simple solutions for disability adjudication in FM because they are generally incompatible with the inherently complex nature of the problem.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Fibromialgia/diagnóstico , Humanos
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