Carine Poppe

Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal

&NA; This paper reports upon: (1) the value of acceptance of pain in predicting well‐being in patients suffering from chronic pain and (2) the construct validity of acceptance by comparing two questionnaires designed to measure acceptance (the Chronic Pain Acceptance Questionnaire, CPAQ, unpublished doctoral dissertation, University of Nevada, Reno, NV, 1992 and the Illness Cognitions Questionnaire, ICQ, J Consult Clin Psychol 69 (2001) 1026). The results of two independent cross‐sectional studies are reported. Study 1 included 120 patients seeking help in tertiary care settings. In Study 2, 66 patients were recruited from a self‐support group for fibromyalgia patients and from a pain clinic. Both studies revealed that acceptance of pain predicted mental well‐being beyond pain severity and pain catastrophizing, but did not account for physical functioning. In both instruments, it was found that acceptance of pain was strongly related to engagement in normal life activities and the recognition that pain may not change. Acceptance in both instruments was strongly related to a cognitive control over pain. Study 2 further revealed that the correlation between the CPAQ and the ICQ is moderate, indicating that both instruments measured different aspects of acceptance. It is concluded that acceptance of chronic pain is best conceived of as the shift away from pain to non‐pain aspects of life, and the shift away from a search for a cure with an acknowledgement that pain may not change.

Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality.

BACKGROUND A low health-related quality of life (HQL) is associated with the evolution of chronic kidney disease (CKD) and mortality in patients in end-stage of the disease. Therefore research on psychological determinants of HQL is emerging. We investigate whether acceptance of the disease contributes to a better physical and mental health-related quality of life (PHQL and MHQL). We also examine the impact of personality characteristics on acceptance, PHQL and MHQL. METHODS In this cross-sectional study, patients from an outpatient clinic of nephrology completed self-report questionnaires on quality of life, acceptance and personality characteristics. We performed correlations, regression analyses and a path analysis. RESULTS Our sample of 99 patients had a mean duration of CKD of 10.81 years and a mean estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD)-formula of 34.49 ml/min (SD 21.66). Regression analyses revealed that acceptance had a significant positive contribution to the prediction of PHQL and MHQL. Neuroticism was negatively associated with acceptance and MHQL. Path analysis showed that 37% of the total effect of neuroticism on MHQL was mediated by acceptance. CONCLUSIONS Acceptance is an important positive variable in accounting for HQL, however, clinicians must be aware that if patients have a high level of neuroticism they are likely to have more difficulties with this coping strategy. These results provide a better understanding of psychological determinants of HQL in CKD, which can initiate another approach of these patients by nephrologists, specific psychological interventions, or other supporting public health services.

Facial Transplantation in a Blind Patient: Psychologic, Marital, and Family Outcomes at 15 Months Follow-Up

BACKGROUND Quality of life has frequently been reported to improve after vascularized composite allotransplantation of the face. However, psychosocial functioning of the partner or of particular patient groups such as blind patients are until now less well investigated. OBJECTIVE The aim of this study is to investigate psychologic, marital, and family functioning of a blind 54-year-old patient, Mr. A, and his partner after facial transplantation. METHODS Depressive and anxiety symptoms, hopelessness, personality, coping, resilience, illness cognitions, marital support, dyadic adjustment, family functioning, and quality of life of Mr. A and his partner were assessed before and after facial transplantation and at 15 months follow-up. Reliable change index (RCI) was further calculated to evaluate the magnitude of change. RESULTS Most psychologic, marital, and family scores of both Mr. A and his partner were within a normative and healthy range before and after transplant and at 15 months follow-up. Resilience (RCI: 3.6), affective responsiveness (RCI: -3.6), and disease benefits (RCI: 2.6) of Mr. A further improved at 15 months follow-up whereas the physical quality of life (RCI: -14.8) strongly decreased. Only marital support (RCI: -2.1) and depth (RCI: -2.0) of the partner decreased at 15 months. CONCLUSIONS The results of this study point to positive psychosocial outcomes in a blind patient after facial transplantation. Further, they may underscore the importance of good psychosocial functioning before transplantation of both partners and of their involvement in psychologic and psychiatric treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.

Cognitive behavior therapy in patients with chronic fatigue syndrome: the role of illness acceptance and neuroticism

OBJECTIVE Increasing the quality of life (QoL) of patients with chronic fatigue is challenging because recovery is seldom achieved. Therefore, it is important to identify processes that improve QoL. This study examined the extent of improvement related to cognitive behavior group therapy (CBT), and whether improvement is affected by initial levels of acceptance and neuroticism. METHODS Eighty CFS patients followed CBT, and self-reported (pre-post design) on mental and physical QoL (MQoL and PQoL), fatigue, acceptance, and neuroticism. The extent of improvement was analyzed using t-tests, effect sizes, and clinically significant change criteria. Whether acceptance and neuroticism at baseline predicted changes was analyzed by means of correlation and regression analyses. RESULTS Significant improvement was found for all variables. The effect size for MQoL and PQoL was small; for acceptance and fatigue, effect size was moderate. About 20% (MQoL) to 40% (fatigue) of the participants clinically improved. Pre-treatment level of acceptance was negatively correlated with changes in MQoL, not with PQoL changes. Neuroticism pre-treatment was positively related with MQoL changes. Regression analysis showed an effect of acceptance on changes in MQoL beyond the effect of neuroticism. CONCLUSIONS Although CBT is an evidence-based treatment, the sizes of the effects are often small regarding QoL. Our study also revealed small effect sizes. Our study showed that patient characteristics at baseline were significantly associated with MQoL outcome; indicating that CFS patients with high neuroticism or with a low acceptance show more improvement in MQoL. We propose to specifically target acceptance and neuroticism before treatment in order to maximize clinical relevance.

Mental quality of life in chronic fatigue is associated with an accommodative coping style and neuroticism: a path analysis.

PurposeAn accommodative coping style (e.g. acceptance) is related to a better mental health-related quality of life (MHQL) in patients with chronic fatigue syndrome (CFS). We want to explore whether neuroticism is predictive for this coping style and MHQL.Secondly we want to explore the relation between acceptance and physical health-related quality of life (PHQL) and expect that illness-related variables such as fatigue severity and duration are related to PHQL.MethodIn this cross-sectional study, 117 patients with chronic fatigue syndrome from an outpatient internal medicine clinic completed self-report questionnaires on quality of life (SF-36), acceptance (ICQ), personality traits (NEO-FFI) and fatigue severity (CIS).ResultsRegression analyses showed that neuroticism and acceptance are predictors of MHQL (38% of the variance was explained). The path analysis showed that acceptance mediates between neuroticism and MHQL and that PHQL is related to MHQL. PHQL is related to fatigue severity and duration, but not to neuroticism and acceptance.ConclusionStimulating an ‘accepting accommodative coping style’ within the treatment for CFS is important in improving mental quality of life. Our results suggest that neuroticism may be negatively related to acceptance and MHQL. This findings support the idea that a psychological diagnostic workout with special attention to personality traits in relation to their coping style is recommended in order to choose the most appropriate therapeutic approach in this population.

PERSONALITY TRAITS IN CHRONIC PAIN PATIENTS ARE ASSOCIATED WITH LOW ACCEPTANCE AND CATASTROPHIZING ABOUT PAIN

Abstract Objective: Pain acceptance is considered important for mental well-being with better functional outcomes for chronic pain patients. The present study explored whether pain-related variables (pain severity, pain interference, pain duration, and pain catastrophizing) and non-pain-related variables (personality traits) influence acceptance and additionally examined the interrelationship between the influencing variables and acceptance. Methods: One hundred patients with chronic pain from a multidisciplinary pain centre completed selfreport questionnaires on acceptance, pain severity, interference of life, pain duration, pain catastrophizing, and personality. Results: Pain severity, pain interference, and pain duration had no significant correlations with acceptance. Pain catastrophizing and most personality traits were significantly and negatively related to acceptance. Regression analyses revealed that of all personality traits, the avoidant personality trait explains most variance of acceptance. Subsequent mediation analysis indicated that catastrophizing about pain mediated the relationship between the avoidant personality trait and acceptance. Conclusion: The findings indicate that acceptance is influenced by catastrophizing and avoidant personality traits. The clinical implication might be that acceptanceoriented treatments may prove less successful in chronic pain patients with more pronounced avoidant personality traits. Extra focus on a reduction of the frequency of pain catastrophizing might be helpful.

Quality of life after liver transplantation: State of the art

Quality of life (QoL) after deceased donor liver transplantation is increasingly recognized as a major outcome parameter. We reviewed recent publications in this rapidly evolving field in order to summarize recent achievements in the field and to define opportunities and perspectives for research and improvement of patient care. QoL does improve after liver transplantation according to a typical pattern. During the first year, there is a significant improvement in QoL. After one year, the improvement does stabilise and tends to decline slightly. In addition to the physical condition, different psychological parameters (such as depression, anxiety, sexual function) and sociodemographic elements (professional state, sex, marital state) seem to impact QoL. Opportunities for further research are the use of dedicated questionnaires and identification of influencing factors for QoL.

Long-term psychosocial outcomes after face transplantation : a patient's and a partner's perspective

To date, psychosocial outcomes after face transplantation are promising, although the impact on family relationships is less well investigated. Depressive and anxiety symptoms, resilience, spousal support, dyadic adjustment, family functioning of a patient and the partner were assessed before, and two, three and four years after the face transplantation. Most psychological, marital and family scores of both partners remained within a normative and healthy range at follow-up. Resilience, affective responsiveness, illness cognitions, physical quality of life, and family affective responsiveness and communication of the patient further improved, whereas the partner reported higher resilience and dyadic consensus at four years after transplantation. The results of this study point to positive long-term psychosocial outcomes of a blind patient and his partner after face transplantation. Practitioner points Psychological health of patient and partner remains good after face transplantation Marital and family functioning remains stable after face transplantation and may even improve Face transplantation may strengthen the resilience of the patient and the partner