Anne L. J. Burke

Child Pornography and the Internet: Policing and Treatment Issues

Arecent increase in the number of referrals for individuals who have accessed child pornography over the Internet has led to a need for clinicians to familiarise themselves with the language and concepts associated with this type of sexual offence. A brief review of the area highlights the legal dilemmas posed by the nature of the Internet. While definitional issues are a primary focus in legal processes, a demonstrated sexual arousal to children is more relevant in therapy. Modifications of traditional treatment approaches are suggested to facilitate therapeutic progress for this population. Discussion focuses on the early motivation for treatment, cognitive distortions, victim impact and cycles of offending behaviour. This work is offered as an early intervention to prevent potential future progression to hands-on sexual offending against children.

Psychological functioning of people living with chronic pain: A meta‐analytic review

OBJECTIVES Chronic pain (CP; >3 months) is a common condition that is associated with significant psychological problems. Many people with CP do not fit into discrete diagnostic categories, limiting the applicability of research that is specific to a particular pain diagnosis. This meta-analysis synthesized the large extant literature from a general CP, rather than diagnosis-specific, perspective to systematically identify and compare the psychological problems most commonly associated with CP. METHODS Four databases were searched from inception to December 2013 (PsychINFO, The Cochrane Library, Scopus, and PubMed) for studies comparing the psychological functioning of adults with CP to healthy controls. Data from 110 studies were meta-analysed and Cohens d effect sizes calculated. RESULTS The CP group reported experiencing significant problems in a range of psychological domains (depression, anxiety, somatization, anger/hostility, self-efficacy, self-esteem and general emotional functioning), with the largest effects observed for pain anxiety/concern and somatization; followed by anxiety and self-efficacy; and then depression, anger/hostility, self-esteem and general emotional functioning. CONCLUSIONS This study demonstrates, for the first time, that individuals with CP are more likely to experience physically focussed psychological problems than other psychological problems and that, unlike self-efficacy, fear of pain is intrinsically tied to the CP experience. This challenges the prevailing view that, for individuals with CP, problems with depression are either equal to, or greater than, problems with anxiety, thereby providing important information to guide therapeutic targets. PRACTITIONER POINTS Positive clinical implications: This is the first time that the CP literature has been synthesized from a general perspective to examine psychological functioning in the presence of CP and provide practical recommendations for assessment and therapy. Individuals with CP were most likely to experience psychological problems in physically focussed areas - namely pain anxiety/concern and somatization. Although fear of pain was intrinsically tied to the CP experience, self-efficacy was not. CP was more strongly associated with anxiety than with depression. Limitations The study focuses on the general CP literature, adults and research-utilizing self-report measures. Meta-analyses are limited by the empirical literature on which they are based.

Psychosocial aspects of spinal cord injury pain: a meta-analysis

Study design:Meta-analysis.Objectives:Although the association between modifiable psychosocial factors and spinal cord injury (SCI) pain has been identified, the full range of psychological and social difficulties for those who experience acute and/or persistent pain remains unclear. This meta-analysis consolidates the available evidence, using the International Classification of Functioning, Disability and Health (ICF) as a reference framework.Methods:Nineteen studies that examined persistent neuropathic, nociceptive or mixed pain subtypes in adults with a SCI (newly acquired and chronic; Nparticipants=2934) were identified from electronic database searches. Standardised mean differences between SCI pain and no-pain groups on self-reported psychosocial outcomes were calculated, along with 95% confidence intervals, fail-safe Ns and heterogeneity statistics.Results:Twenty individual outcomes were grouped into nine ICF-related categories. Emotional functions were the most frequent (100%) psychosocial outcomes assessed, with pain contributing to heightened stress (d=−0.85), depression (d=−2.49) anxiety (d range=−0.85 to −1.45), poor self-efficacy (d=−0.77), lowered wellbeing (d range=−0.67 to −1.02) and decreased use of adaptive coping, such as illness acceptance (d=−0.85). Activity limitations and participation restriction were examined by seven studies (43%), although these findings were largely characterised by single studies.Conclusions:Multicomponent treatments that target mood disturbance and foster community connections are important in SCI pain management. However, to improve the comparability of future studies, SCI pain research must adopt definitions of pain consistent with the International Spinal Cord Injury Pain Classification along with validated outcomes that map onto the ICF framework.

Waiting for multidisciplinary chronic pain services: A prospective study over 2.5 years

Despite many patients waiting more than 2 years for treatment at publicly funded multidisciplinary chronic pain services, waitlist studies rarely examine beyond 6 months. We investigated psychological adjustment and health-care utilisation of individuals (N = 339) waiting ≤30 months for appointments at an Australian tertiary pain unit. Outcomes were relatively stable during the first 6 months, but long-term deteriorations in pain-related interference, distress and pain acceptance were evident, albeit with sex differences. Sexes also differed in uptake of new treatments. Medication use increased over time, but pain severity and medication relief did not. Results suggest that early intervention is important, especially for women.

T1253 Does Cognitive-Behavioural Therapy (CBT) Improve Outcomes in Inflammatory Bowel Disease (IBD)? Initial Feasibility Report on a Pilot Randomised Controlled Trial

evaluated using the Egger test. Results: There were 8 RCTs involving 589 patients. Antibiotics were evaluated as single (5 RCTs) or combination (3 RCTs). For all trials, adjunctive steroids were used during induction. Other therapies permitted between both groups included 5ASA, immunomodulators, and probiotics. Overall, there was a trend for antibiotic therapy to be more effective than placebo but this did not achieve statistical significance (RR no remission = 0.69; 95% CI = 0.47 to 1.01, p=0.06). There was moderate heterogeneity between results (I2 = 66%) and no statistically significant funnel plot asymmetry (p = 0.10). Trials that gave improvement in UC as an outcome were included in a sensitivity analysis. There were 10 RCTs involving 661 patients and now there was a statistically significant beneficial effect of antibiotics compared to placebo (RR no remission = 0.66; 95% CI = 0.46 to 0.96, p=0.03) with moderate heterogeneity between results (I2 = 65%). The NNT = 7 (95% CI = 4 to 20). Conclusions: There is a trend towards benefit of antibiotics as adjunctive therapy to steroids in inducing remission in active UC. This did not achieve statistical significance in the primary analysis and the different antibiotics assessed makes the results difficult to interpret. These data suggest future RCTs of antibiotics in UC would be useful.