Anton Leitner

The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis

BACKGROUND There is strong evidence indicating an interaction between sleep and pain. However, the size of this effect, as well as the clinical relevance, is unclear. Therefore, this meta-analysis was conducted to quantify the effect of sleep deprivation on pain perception. METHODS A systematic literature search was conducted using the electronic databases PubMed, Cochrane, Psyndex, Psycinfo, and Scopus. By conducting a random-effect model, the pooled standardized mean differences (SMDs) of sleep deprivation on pain perception was calculated. Studies that investigated any kind of sleep deprivation in conjunction with a pain measurement were included. In cases of several pain measurements within a study, the average effect size of all measures was calculated. RESULTS Five eligible studies (N = 190) for the between-group analysis and ten studies (N = 266) for the within-group analysis were identified. Sleep deprivation showed a medium effect in the between-group analysis (SMD = 0.62; CI95: 0.12, 1.12; z = 2.43; p = 0.015) and a large effect in the within-group analysis (SMD = 1.49; CI95: 0.82, 2.17; z = 4.35; p <0.0001). The test for heterogeneity was not significant in the between-group analysis (Q = 5.29; df = 4; p = 0.2584), but it was significant in the within-group analysis (Q = 53.49; df = 9; p <0.0001). CONCLUSION This meta-analysis confirms a medium effect (SMD = 0.62) of sleep deprivation on pain perception. As this meta-analysis is based on experimental studies in healthy subjects, the clinical relevance should be clarified.

Patients’ Perceptions of Risky Developments During Psychotherapy

Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.

Guided self-help interventions for irritable bowel syndrome: a systematic review and meta-analysis.

Objective Although irritable bowel syndrome (IBS) is highly prevalent and is accompanied by high costs for respective healthcare systems, the data on treatment effectiveness are limited. Current treatment methods have limitations in terms of side effects and availability. Guided self-help (GSH) might be an easily accessible and cost-effective treatment alternative. This study is the first systematic review and meta-analysis of GSH interventions for IBS. Methods Using electronic databases (MEDLINE, SCOPUS, PsycINFO, and Web of Science), we performed a systematic search for randomized-controlled trials. Using a random-effect model, we calculated the pooled standardized mean differences (SMDs) of GSH on IBS symptom severity (primary outcome) and quality of life (secondary outcome). We additionally examined the moderating effects of online-based interventions and face-to-face therapist contact by applying mixed models. Results A systematic literature search identified 10 eligible randomized-controlled trials, including 886 participants. Compared with the control conditions, the effect size was medium for the decrease in IBS symptom severity (SMD=0.72; 95% confidence interval: 0.34–1.08) and large for the increase in patients’ quality of life (SMD=0.84; 95% confidence interval: 0.46–1.22). Neither treatment format nor face-to-face contact was a predictor of therapy outcomes in between-group analyses. In contrast, within-group analyses led to the conclusion that online-based interventions are more effective than other self-help formats. Conclusion GSH is an effective alternative for the treatment of IBS. As GSH methods are easy to implement, it seems sensible to integrate GSH into clinical practice. Limitations With respect to the high study heterogeneity, the number of studies included was relatively small.

A meta‐analytic review of brief guided self‐help education for chronic pain

Up to 30% of the population in Western countries suffer from chronic pain. The treatment of chronic pain causes medical and socioeconomic problems. Guided self‐help (GSH) might be an effective supplementary treatment, however, the size of this effect is unclear. This meta‐analysis quantifies the effect of GSH on chronic pain. A systematic literature search was conducted using PubMed, Cochrane, Psyndex, Psycinfo and Scopus. Studies that investigated GSH in chronic pain conditions (children and adults) were included. Disability, quality of life and pain severity were defined as main outcomes. We conducted random effects models to calculate standardized mean differences (SMDs). By applying mixed models and subgroup analyses, we examined the moderating effects of sample characteristics (age; pain region), GSH format (online; face‐to‐face contact) and study characteristics (study quality; control condition). We identified 16 eligible studies, including 739 subjects. Between‐group analyses resulted in a medium, but heterogeneous effect size for pain severity (SMD = 0.51; CI95: 0.21, 0.81). After excluding two samples suggesting small study bias, the effect on pain severity was small but homogeneous (SMD = 0.34; CI95: 0.13, 0.54). We found a small effect size for disability (SMD = 0.30; CI95: 0.10, 0.50). The pooled effect size for quality of life did not reach significance (SMD = 0.24; CI95: −0.07, 0.54). We conclude that GSH has a small but robust effect on pain severity and disability in chronic pain patients. This applies to various GSH formats and patient populations. It seems reasonable to integrate GSH into clinical practice as a supplemental treatment option.

Wie belastend ist die Behandlung von Patienten mit somatoformen Störungen

OBJECTIVES This study examines the influence of self-perceived emotional stress during the treatment of patients with somatoform disorders. It asks whether emotional stress can be influenced by psychosomatic education. METHODS Via online questionnaire general practitioners were asked about the prevalence of patients presenting with somatoform disorders and emotional stress during treatment. RESULTS The prevalence of somatoform disorders in general practices was estimated at around 27.7 %. Practitioners educated in psychosomatic medicine estimate the prevalence of patients with somatoform disorders higher than practitioners without such education (n = 79; r = 0.242; p = 0.032). The treatment of patients presenting with somatoform disorders causes 42.6% more emotional stress among general practitioners compared with the treatment of an average patient (n = 79; t = 16.67; p ≤ 0.001). Doctors with additional education in psychosomatic medicine rate stress 17.2% lower than doctors without such education (n = 79; t = 1.875; p = 0.033). CONCLUSIONS General practitioners experience the treatment of patients presenting with somatoform disorders as emotionally stressful. This emotional stress is mainly explained by increases in time expenditure, but it can be reduced by additional psychosomatic education.

Austrian expenditures on psychopharmaceutical drugs between 2006 and 2013

OBJECTIVES Health costs, which are increasing at a yearly rate of 4 %, represent 11% and thus a large share of Austrias gross domestic product (GDP). High expenditures derive frommental health care costs, including medication. In this article we investigate whether the costs and usage of psychopharmaceutic products in Austria are rising. METHOD We did a descriptive analysis of the sales figures and number for packaging units of pharmaceutical products of ATC-classes N05 and N06 in all Austrian hospitals, pharmacies and medicine chests for the years 2006-2013. All data were provided free of charge by IMSHealth. RESULTS The sales volume and number of prescribed packaging units of pharmaceuticals of ATC-classes N05 and N06 increased over the time period in question. In 2013, about 25% more packaging units were being sold than in 2006. Among the two ATC-classes, however, the indication subgroups developed differently. Expenditures increased a total of about 31%within the period of consideration. CONCLUSIONS The increase in psycho-pharmaceutical sales exceeds the expansion rates of other health expenditures (17.8 %). During the 9 years of observation, 25% more psychopharmaceutical products were sold. This may result from increased prevalence of mental disorders, higher usage or an increment in prescriptions.