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Mindfulness, Acceptance and Catastrophizing in Chronic Pain  [PDF]
Maaike J. de Boer, Hannemike E. Steinhagen, Gerbrig J. Versteegen, Michel M. R. F. Struys, Robbert Sanderman
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087445
Abstract: Objectives Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain. Methods A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center. Results The results show that general psychological acceptance (measured with the AAQ-II) is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS) did not predict levels of pain-related catastrophizing. Discussion Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of “acting with awareness” is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.
Laparoscopic findings in chronic pelvic pain  [PDF]
J Bajracharya,NS Shrestha,C Karki,R Saha
Journal of Kathmandu Medical College , 2012, DOI: 10.3126/jkmc.v1i2.8146
Abstract: Background: Chronic pelvic pain is a common problem in reproductive age group women. Diagnosis of chronic pelvic pain needs multidisciplinary approach. Diagnostic laparoscopy is one of the investigations which can help in reaching the diagnosis. Objective: To know the etiology in chronic pelvic pain. Methods: This was a descriptive study done in the Department of Obstetrics and Gynaecology of Kathmandu medical college teaching hospital from January 2010 to June 2012 (30 months). All the cases of laparoscopic surgery done for chronic pelvic pain were noted and details of these cases were analyzed regarding age, parity and laparoscopic findings. Results: Total 48 cases of Chronic Pelvic Pain underwent diagnostic laparoscopy during the study period. Mean age of cases were 33 years, ranging from 20-46yrs. Almost half of the cases 43.75% were of parity two. Laparoscopic finding was negative in 29.17% and pelvic pathology was present in 70.83% of the cases. Out of the pelvic pathology endometriosis was present in 55.88% followed by pelvic adhesions, pelvic congestion and pelvic inflammatory disease, chronic ectopic in 20.58%, 14.70%, 5.88%, 2.94% respectively. Conclusion: Diagnostic laparoscopy is a useful modality in the diagnosis of etiology and management of Chronic pelvic pain. In our study, Pelvic endometriosis was the most common pelvic pathology in cases of Chronic pelvic pain. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8146 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 100-102
The role of psychological interventions in the management of patients with chronic pain
Roditi D, Robinson ME
Psychology Research and Behavior Management , 2011, DOI: http://dx.doi.org/10.2147/PRBM.S15375
Abstract: ole of psychological interventions in the management of patients with chronic pain Review (5968) Total Article Views Authors: Roditi D, Robinson ME Published Date May 2011 Volume 2011:4 Pages 41 - 49 DOI: http://dx.doi.org/10.2147/PRBM.S15375 Daniela Roditi, Michael E Robinson Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA Abstract: Chronic pain can be best understood from a biopsychosocial perspective through which pain is viewed as a complex, multifaceted experience emerging from the dynamic interplay of a patient's physiological state, thoughts, emotions, behaviors, and sociocultural influences. A biopsychosocial perspective focuses on viewing chronic pain as an illness rather than disease, thus recognizing that it is a subjective experience and that treatment approaches are aimed at the management, rather than the cure, of chronic pain. Current psychological approaches to the management of chronic pain include interventions that aim to achieve increased self-management, behavioral change, and cognitive change rather than directly eliminate the locus of pain. Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress – improvements that are effected via a variety of effective self-regulatory, behavioral, and cognitive techniques. Through implementation of these changes, psychologists can effectively help patients feel more in command of their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives.
Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence  [PDF]
Linda E. Carlson
ISRN Psychiatry , 2012, DOI: 10.5402/2012/651583
Abstract: Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes. 1. Introduction, Scope, and Chapter Outline This paper summarizes the growing literature investigating the application of mindfulness-based interventions (MBIs) for people coping with a wide array of physical diseases and conditions. Mindfulness can be defined as the application of nonjudgmental present-focused awareness to the totality of experience moment by moment [1, 2]. This is often contrasted to the typical state of mental activity, which is to be thinking about the past, planning for the future, or analyzing and processing current experience, often with a tone of judgment or impatience. Mindfulness is both a practice, but also a way of being in the world. In formal mindfulness mediation practice, the focus is often purposefully directed towards the breath, body sensations, feelings, or thoughts, but it can also be simply bare awareness of whatever arises into consciousness moment by moment. Mindfulness practices emphasize not only the aspect of focusing awareness in the present moment, but also the attitudes with which
The role of psychological interventions in the management of patients with chronic pain  [cached]
Roditi D,Robinson ME
Psychology Research and Behavior Management , 2011,
Abstract: Daniela Roditi, Michael E RobinsonDepartment of Clinical and Health Psychology, University of Florida, Gainesville, FL, USAAbstract: Chronic pain can be best understood from a biopsychosocial perspective through which pain is viewed as a complex, multifaceted experience emerging from the dynamic interplay of a patient's physiological state, thoughts, emotions, behaviors, and sociocultural influences. A biopsychosocial perspective focuses on viewing chronic pain as an illness rather than disease, thus recognizing that it is a subjective experience and that treatment approaches are aimed at the management, rather than the cure, of chronic pain. Current psychological approaches to the management of chronic pain include interventions that aim to achieve increased self-management, behavioral change, and cognitive change rather than directly eliminate the locus of pain. Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress – improvements that are effected via a variety of effective self-regulatory, behavioral, and cognitive techniques. Through implementation of these changes, psychologists can effectively help patients feel more in command of their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives.Keywords: chronic pain management, psychology, multidisciplinary pain treatment, cognitive behavioral therapy for pain
Treatment Expectations for CAM Interventions in Pediatric Chronic Pain Patients and their Parents  [PDF]
Jennie C. I. Tsao,Marcia Meldrum,Brenda Bursch,Margaret C. Jacob,Su C. Kim,Lonnie K. Zeltzer
Evidence-Based Complementary and Alternative Medicine , 2005, DOI: 10.1093/ecam/neh132
Abstract: Patient expectations regarding complementary and alternative medicine (CAM) interventions have important implications for treatment adherence, attrition and clinical outcome. Little is known, however, about parent and child treatment expectations regarding CAM approaches for pediatric chronic pain problems. The present study examined ratings of the expected benefits of CAM (i.e. hypnosis, massage, acupuncture, yoga and relaxation) and conventional medicine (i.e. medications, surgery) interventions in 45 children (32 girls; mean age = 13.8 years ± 2.5) and parents (39 mothers) presenting for treatment at a specialty clinic for chronic pediatric pain. Among children, medications and relaxation were expected to be significantly more helpful than the remaining approaches (P < 0.01). However, children expected the three lowest rated interventions, acupuncture, surgery and hypnosis, to be of equal benefit. Results among parents were similar to those found in children but there were fewer significant differences between ratings of the various interventions. Only surgery was expected by parents to be significantly less helpful than the other approaches (P < 0.01). When parent and child perceptions were compared, parents expected hypnosis, acupuncture and yoga, to be more beneficial than did children, whereas children expected surgery to be more helpful than did parents (P < 0.01). Overall, children expected the benefits of CAM to be fairly low with parents' expectations only somewhat more positive. The current findings suggest that educational efforts directed at enhancing treatment expectations regarding CAM, particularly among children with chronic pain, are warranted.
Mindfulness, cancer, and pain  [cached]
Anna M. Tacon
Alternative Medicine Studies , 2011, DOI: 10.4081/ams.2011.e15
Abstract: Pain is the most distressing and incapacitating symptom experienced by cancer patients. While mindfulness-based stress reduction (MBSR) interventions have been conducted with cancer patients, no study has explored psychological and pain- related factors in patients with cancer-related pain. The effects of an eight-week MBSR intervention were investigated on pre- post scores for pain catastrophizing, pain-related anxiety, pain intensity ratings, and mental adjustment to cancer in breast cancer patients with pa in. Forty-one women diagnosed withcancer-related pain participated in the study. The MBSR was conducted for 1.5 hours/week for eight-weeks; participants were trained in the body scan, sitting meditation, and hatha yoga. Results showed significant reduction in scores for pain catastrophizing, pain anxiety, and painratings; also significant positive changes occurred for mental adjustment to cancer. This study is the first to investigate MBSR effects for psychological factors in patients with cancer pain. Much more research is needed in this area.
Mindfulness-based stress reduction for low back pain. A systematic review  [cached]
Cramer Holger,Haller Heidemarie,Lauche Romy,Dobos Gustav
BMC Complementary and Alternative Medicine , 2012, DOI: 10.1186/1472-6882-12-162
Abstract: Background Mindfulness-based stress reduction (MBSR) is frequently used for pain conditions. While systematic reviews on MBSR for chronic pain have been conducted, there are no reviews for specific pain conditions. Therefore a systematic review of the effectiveness of MBSR in low back pain was performed. Methods MEDLINE, the Cochrane Library, EMBASE, CAMBASE, and PsycInfo were screened through November 2011. The search strategy combined keywords for MBSR with keywords for low back pain. Randomized controlled trials (RCTs) comparing MBSR to control conditions in patients with low back pain were included. Two authors independently assessed risk of bias using the Cochrane risk of bias tool. Clinical importance of group differences was assessed for the main outcome measures pain intensity and back-specific disability. Results Three RCTs with a total of 117 chronic low back pain patients were included. One RCT on failed back surgery syndrome reported significant and clinically important short-term improvements in pain intensity and disability for MBSR compared to no treatment. Two RCTs on older adults (age ≥ 65 years) with chronic specific or non-specific low back pain reported no short-term or long-term improvements in pain or disability for MBSR compared to no treatment or health education. Two RCTs reported larger short-term improvements of pain acceptance for MBSR compared to no treatment. Conclusion This review found inconclusive evidence of effectiveness of MBSR in improving pain intensity or disability in chronic low back pain patients. However, there is limited evidence that MBSR can improve pain acceptance. Further RCTs with larger sample sizes, adequate control interventions, and longer follow-ups are needed before firm conclusions can be drawn.
MRI FINDINGS DO NOT CORRELATE WITH OUTCOME IN ATHLETES WITH CHRONIC GROIN PAIN  [cached]
Adrien Daigeler,Orlin Belyaev,Werner H. Pennekamp,Stephan Morrosch
Journal of Sports Science and Medicine , 2007,
Abstract: This trial aimed to assess the value of MRI in the differential diagnosis of chronic groin pain in athletes, a condition caused by various pathologies, the most common being posterior abdominal wall deficiency, osteitis pubis and muscular imbalance. Nineteen subjects with clinically ruled-out hernia and recurrent episodes of exercise-triggered groin pain were assessed. Dynamic MRI was performed under Valsalva manoeuver and at rest within a training- free period and after training activity. Follow-up was performed after 4 years using a questionnaire and physical examination. An incipient hernia was seen in one case, Valsalva manoeuver provoked a visible bulging in 7 others (3 bilateral). Eight athletes showed symphysitis (accompanied by bulging in 3 cases). MRI visualized one hydrocele, one osteoma of the left femur, one enchondroma of the pubic bone, and one dilated left ureter without clinical symptoms or therapeutic relevance. MRI findings after training and during the training free period did not vary. Fifteen participants were available for a follow-up control examination 4 years later - one suffered from ongoing pain, eleven were free of symptoms and three had improvement. However, most of them improved only with changing or reducing training. There were four participants with a specific therapy of their MRI findings. MRI revealed a variety of pathological findings in athletes suffering from chronic groin pain, but it was not reliable enough in differentiating between diagnoses requiring conservative or operative treatment. The MRI examination within the training interval did not have an advantage to that within the training-free period. Further randomized prospective trials with a long follow-up should establish whether MRI findings could be of help in the choice between conservative and surgical treatment for chronic groin pain
Comparison of laparoscopic findings in women with chronic pelvic pain with findings of pain free women who were candidate for laparoscopic tubal sterilization
Djamal A
Tehran University Medical Journal , 1998,
Abstract: The laparoscopic findings of 32 patients with chronic pelvic pain were compared with findings of 62 pain free women who were candidates for laparoscopic tubal sterilization. The most common findings, normal pelvis, was found in 50% of patients and 80.6% of controls that was statistically significant (P<0.01). There was no significant difference with pelvic adhesions, polycystic ovaries, pelvic relaxation between study and comparison group.
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