Efecto diferencial de una intervención breve basada en la conciencia plena (mindfulness) y valores en las dimensiones del dolor crónico en espondilitis y artritis / Differential effect of brief values and mindfulness-based intervention in chronic pain dimensions for spondylitis and arthritis

En el modelo multidimensional del dolor se destaca la influencia de los componentes emocionales y cognitivos en la experiencia subjetiva del mismo. Desde esta perspectiva, se hace imprescindible el tratamiento psicológico para facilitar su afrontamiento. El presente estudio examinó los efectos diferenciales de una intervención breve basada en conciencia plena y valores en las diversas dimensiones del dolor crónico asociado a las enfermedades reumáticas. Se evaluaron a 10 participantes mediante el "Cuestionario de dolor, de McGuill" y una escala de "Preocupación y autoeficacia". Los resultados mostraron la eficacia de la intervención para mejorar la dolencia de la enfermedad, disminuyendo en la evaluación pos-intervención específicamente el componente valorativo del dolor, la percepción de la intensidad actual del mismo y la preocupación respecto al dolor. Asimismo, en la evaluación del seguimiento a los 8 meses se encontró una educción en el número de puntos considerados dolorosos. Nuestro estudio, pese a sus limitaciones metodológicas, ofrece unos resultados prometedores que sugieren la utilidad de la intervención en conciencia plena y valores para el manejo del dolor crónico en las enfermedades reumáticas (AU)

The multidimensional model of pain emphasizes the influence of emotional and cognitive components in the subjective experience of pain. From this perspective, the successful management of pain seems to require psychological treatment. The present study examined the differential effects of a brief psychological intervention program based on mindfulness and values in the diverse dimensions of chronic pain associated with rheumatic disease. Ten participants were assessed with the McGuill's Pain Questionnaire and a Scale of Worry and Self-efficacy. The results indicate that the intervention program improved the management of pain at post-intervention assessment, showing specific reductions in the following dimensions: evaluative component of pain, perception of actual pain intensity and worry about illness and pain. In addition, a reduction in amount of painful points was found at 8-months follow-up. Despite its methodological limitations, our results suggest that a brief mindfulness and values-based intervention can be useful in the management of pain in patients with chronic rheumatic conditions

Typhoid spine: somatic versus psychosomatic diagnosis in Osler's time.

OBJECTIVE: To review the history of typhoidal spondylitis as a paradigm of conflicts between medical and psychiatric diagnoses. METHODS: Because William Osler was the principal advocate for a psychogenic cause of this disease, all of his relevant writings are reviewed together with pertinent psychiatric concepts of the late 19th century, as well as the relevant bacteriologic and clinical research. RESULTS: Bacteriologic research had advanced sufficiently by 1903 that "typhoid spine" could be proved an osteomyelitis. Nevertheless, the belief that at least some cases were manifestations of a traumatic neurosis analogous to "railway spine" persisted, the trauma having been the acute typhoid infection. The last vestiges of this concept were represented by Osler's article of 1919. CONCLUSIONS: Osler's 25 year struggle to understand typhoidal spondylitis is an example of the persistent tendency of physicians to attribute a psychologic cause to a syndrome, often pejoratively, because of the absence of a sufficient pathophysiologic explanation or reluctance to acknowledge a new concept.

[The psychological characteristics of patients with neurological manifestations of lumbar osteochondrosis]. / Psikhologicheskaia kharakteristika bol'nykh s nevrologicheskimi proiavleniiami poiasnichnogo osteokhondroza.

Both clinical-neurological and psychological examinations of 42 patients with neurological manifestations of lumbar osteochondrosis with chronic or chronic recurring course were carried out. The main features of personality in most cases were anxiety, hypochondria, passivity and demonstrativity. The clinical signs of nonspecific psycho-emotional tension was found in 70% of cases. Its level correlated negatively with the effectiveness of the treatment. It was established that the negative influence of personality on the course of disease and on the effectiveness of its therapy was connected with the predisposition of such individuals to unfavourable type of reaction toward disease and to development of psychic adaptation disorders.

[The vertebroneurological problems of pain]. / Vertebronevrologicheskie problemy boli.

The following aspects of pain theory essential for clinical vertebroneurology were examined in article, namely: vertebral receptors irritation as the source of vertebral pains, multitude of vertebroneurological syndromes factors, psychogenic factors of pain experience, diagnostic estimation of pain and effectiveness of medical influences on ache. Unpunctuality and deontological unjustification of disease definition by pain sign as well as estimation of treatment results according to direct analgetic effect were emphasized.

[Psychoautonomic disorders in painful vertebrogenic syndromes]. / Psikhovegetativnye rasstroistva pri bolevykh vertebrogennykh sindromakh.

Compression spectral analysis of EEG and electropolygraphic registration (EMG, SGR, ECG), psychological and clinical investigations were used to examine patients with right and left vertebrogenic pain syndrome, patients with psychogenic neurotic syndrome and control group of healthy subjects. It was found that vertebrogenic syndrome frequently combined with psychogenic disorders. The latter were more evident in the left-side syndromes, occurred in more severe EEG abnormality. The role of the right hemisphere in the genesis of the above disorders in the patients and the problem of the center-periphery relations in pain vertebrogenic syndromes are discussed.

[Hormonal profile in chronic pain syndromes of somatogenic etiology]. / Gormonal'nyi profil' pri khronicheskikh bolevykh sindromakh somatogennogo proiskhozhdeniia.

The integral "profile" of the groups of inpatients suffering from somatogenic chronic painful syndromes was plotted on a material of a comprehensive study into central and peripheral hormones, the total content, and correlations. Enkephalins are shown to play the integrating part in the development of stress-algogenic reactions.

[Incongruous pain in patients with spinal osteochondrosis]. / Nekongruéntnye boli u bol'nykh s osteokhondrozom pozvonochnika.

The article is devoted to the investigation of actual at present problem of incongruent pain in patients with spine osteochondrosis. 26 patients with congruent and 24 patients with incongruent pain, intensity and localization of which did not correspond to organic disturbances, have been examined. The results of comparison of two groups demonstrated involvement of central mechanisms, namely physiologic, in the pain syndrome formation in patients with incongruent pain. They demonstrate the necessity of differentiated approach in the treatment of the patients of the mentioned group, including psychotherapeutic measures.

[Personality structure of chronic rheumatically ill females]. / Die Persönlichkeitsstruktur chronisch rheumatisch erkrankter Frauen.

80 female patients were tested for personality differences by the Freiburg Personality Inventory and the Giessen Test Self Image. They were divided into four groups with 20 patients each, suffering from rheumatoid arthritis, ankylosing spondylitis, spondylosis and coxarthrosis. While RA patients did not significantly differ from AS patients, nor spondylosis patients from coxarthrosis patients, certain personality differences were detected between the patients with inflammatory and those with degenerative rheumatic diseases. These results, however, do not allow us to draw the conclusion that a "degenerative or inflammatory rheumatic personality" exists. Besides the Giessen Test Self Image the Giessen Test Self Ideal was also administered to all of the patients. In all four groups the desire for a better basic mood and less depression was prevailing. RA patients also wanted more "social resonance" and "predominance". AS patients wanted significantly less "control" and more "responsiveness". These components should be given special consideration in the psychological care of rheumatic patients.