Daphne C. McKee

Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction

To understand the disorders of bowel motility, it is important to know the range of bowel patterns in the general population. We have devised a brief self-administered questionnaire which, when used among a group of 789 students and hospital employees, disclosed that 94.2% had stool frequencies between three per day and three per week, and that 17.1% had bowel dysfunction. When compared with the remaining sample, the bowel dysfunction group was predominantly female. This group also reported more often that stress influenced their bowel function, and more often used laxatives and visited physicians for bowel complaints. Further medical evaluation to characterize this subgroup is needed. We believe that selection, for psychologic and physiologic study, of subjects with bowel dysfunction not seeking health care will provide a needed comparison group in our understanding of patients with irritable bowel syndrome.

Pain Catastrophizing and Pain-Related Fear in Osteoarthritis Patients: Relationships to Pain and Disability

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps < or = 0.05) of variance in measures of pain (partial r(2) [pr(2)] = 0.10), psychological disability (pr(2) = 0.20), physical disability (pr(2) = 0.11), and gait velocity at normal (pr(2) = 0.04), fast (pr(2) = 0.04), and intermediate speeds (pr(2) = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr(2) = 0.07) and walking at a fast speed (pr(2) = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.

Recollection of childhood events in adults with irritable bowel syndrome

We examined retrospectively premorbid factors that might relate to the development of irritable bowel syndrome (IBS). We administered a semistructural interview to adult IBS patients, adults with symptoms of IBS who had not visited a doctor (nonpatients), and asymptomatic normals. Patients with IBS differed from nonpatients by reporting more severe bowel problems, more frequent doctor visits in childhood, and more pain associated with current bowel symptoms. These factors may contribute to the tendency of people with bowel symptoms to seek medical care. More patients, and in most cases nonpatients with IBS, reported poorer general health and headaches, stomachaches, and bowel complaints during childhood. They also showed evidence for greater parental attention to illness with more frequent school absences and doctor visits than normal subjects. Loss and separation during childhood, and in the current family, and conflicted or dependent maternal relationships were also more frequently reported among patients and nonpatients. These factors may contribute to the development of IBS.

Facilitating research participation and improving quality of life for African American prostate cancer survivors and their intimate partners. A pilot study of telephone-based coping skills training.

African American men experience worse prostate cancer outcomes compared with those of Caucasian men, not only in incidence and mortality rates, but also in coping with the side effects of treatment. Unfortunately, African American men have been significantly under‐represented in research evaluating the efficacy of psychosocial interventions for improving coping in prostate cancer survivors. This pilot study explored the feasibility and efficacy of coping skills training (CST), an intervention developed to enhance coping with treatment side effects in a sample of African American prostate cancer survivors and their intimate partners. The intervention was delivered in a telephone‐based format designed to facilitate research participation. A total of 40 couples were randomized to either 6 sessions of CST or usual care. Survivors completed measures of disease‐specific quality of life (QOL) related to urinary, sexual, bowel, and hormonal symptom domains, as well as measures of global QOL (i.e., physical functioning and mental health). Partners completed measures of caregiver strain, mood, and vigor. Analysis of data from 30 couples (12 couples in CST, 18 couples in usual care) indicated that CST produced moderate to large treatment effects for QOL related to bowel, urinary, sexual, and hormonal symptoms. Partners who underwent CST reported less caregiver strain, depression, and fatigue, and more vigor, with moderate effect sizes observed that approached conventional levels of statistical significance. These preliminary findings suggest that telephone‐based CST is a feasible approach that can successfully enhance coping inAfrican American prostate cancer survivors and their intimate partners. Cancer 2007.

Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: A randomized controlled study

Summary Combined training in pain and weight management in overweight and obese OA patients resulted in improved pain and other outcomes compared to either training alone. ABSTRACT Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long‐term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (n = 232) were randomized to a 6‐month program of: 1) PCST + BWM; 2) PCST‐only; 3) BWM‐only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self‐efficacy, weight self‐efficacy), and body weight were collected at 4 time points (pretreatment, posttreatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST + BWM demonstrated significantly better treatment outcomes (average of all 3 posttreatment values) in terms of pain, physical disability, stiffness, activity, weight self‐efficacy, and weight when compared to the other 3 conditions (Ps < 0.05). PCST + BWM also did significantly better than at least one of the other conditions (ie, PCST‐only, BWM‐only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self‐efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long‐term benefits.

Caregiver-Assisted Coping Skills Training for Lung Cancer: Results of a Randomized Clinical Trial

CONTEXT Lung cancer is one of the most common cancers in the United States and is associated with high levels of symptoms, including pain, fatigue, shortness of breath, and psychological distress. Caregivers and patients are adversely affected. However, previous studies of coping skills training (CST) interventions have not been tested in patients with lung cancer nor have systematically included caregivers. OBJECTIVES This study tested the efficacy of a caregiver-assisted CST protocol in a sample of patients with lung cancer. METHODS Two hundred thirty-three lung cancer patients and their caregivers were randomly assigned to receive 14 telephone-based sessions of either caregiver-assisted CST or education/support involving the caregiver. Patients completed measures assessing pain, psychological distress, quality of life (QOL), and self-efficacy for symptom management; caregivers completed measures assessing psychological distress, caregiver strain, and self-efficacy for helping the patient manage symptoms. RESULTS Patients in both treatment conditions showed improvements in pain, depression, QOL, and self-efficacy, and caregivers in both conditions showed improvements in anxiety and self-efficacy from baseline to four-month follow-up. Results of exploratory analyses suggested that the CST intervention was more beneficial to patients/caregivers with Stage II and III cancers, whereas the education/support intervention was more beneficial to patients/caregivers with Stage I cancer. CONCLUSION Taken together with the broader literature in this area, results from this study suggest that psychosocial interventions can lead to improvements in a range of outcomes for cancer patients. Suggestions for future studies include the use of three-group designs (e.g., comparing two active interventions with a standard-care control) and examining mechanisms of change.

Urgency and fecal soiling in people with bowel dysfunction.

The frequency of urgency and fecal soiling in the population and among people with irritable bowel syndrome (IBS), and the association of these symptoms with health care seeking is unknown. Among 1128 students and hospital employees that we surveyed, urgency was reported in 14.4%, fecal soiling in 5.3%, and diarrhea in 9.0%. Most persons with fecal soiling did not report urgency or diarrhea. Although bowel dysfunction compatible with IBS was present in 20% (227), only 29% of this group (65) had seen a physician for bowel complaints. People with bowel dysfunction were more likely to be women, to take laxatives, and to have rectal urgency. Fecal soiling was more likely among those with bowel dysfunction who had been to the doctor, and included almost half of the men in this group. There was no difference in the frequency of diarrhea reported among those with bowel dysfunction regardless of whether they had been to the doctor. These data suggest fecal soiling may influence people with bowel dysfunction to go to the doctor. Physiological studies are needed to determine if anal sphincter dysfunction is a component of IBS.

Pain Coping Skills Training for Patients With Elevated Pain Catastrophizing Who Are Scheduled for Knee Arthroplasty: A Quasi-Experimental Study

OBJECTIVES To (1) describe a behavioral intervention designed for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty, and (2) use a quasi-experimental design to evaluate the potential efficacy of the intervention on pain severity, catastrophizing cognitions, and disability. DESIGN Quasi-experimental nonequivalent control group design with a 2-month follow-up. SETTING Two university-based orthopedic surgery departments. PARTICIPANTS Adults (N=63) scheduled for knee replacement surgery who reported elevated levels of pain catastrophizing. Patients were recruited from 2 clinics and were assessed prior to surgery and 2 months after surgery. INTERVENTIONS A group of 18 patients received a psychologist-directed pain coping skills training intervention comprising 8 sessions. The other group, a historical cohort of 45 patients, received usual care. MAIN OUTCOME MEASURES Western Ontario and McMaster Universities Arthritis Index Pain and Disability scores, as well as scores on the Pain Catastrophizing Scale. RESULTS Two months after surgery, the patients who received pain coping skills training reported significantly greater reductions in pain severity and catastrophizing, and greater improvements in function as compared to the usual care cohort. CONCLUSIONS Pain catastrophizing is known to increase risk of poor outcome after knee arthroplasty. The findings provide preliminary evidence that the treatment may be highly efficacious for reducing pain, catastrophizing, and disability, in patients reporting elevated catastrophizing prior to knee arthroplasty. A randomized controlled trial is warranted to confirm these effects.

Intellectual functioning in renal failure and chronic dialysis

The research literature on intellectual functioning in uremia and maintenance hemodialysis for renal failure is critically reviewed. The most frequently assessed neuropsychological functions have been general intelligence, memory, and attentional processes. Studies have consistently found lowered performance IQ scores compared to verbal IQ scores in renal failure patients prior to dialysis onset, suggesting the presence of intellectual deficit due to cortical dysfunction. The role of intelligence in adjustment to dialysis has not been clearly explicated, due in part to methodological variations among studies. Several studies point to significant improvement in short-term memory both after onset of maintenance dialysis and from one day before to one day after an individual dialysis treatment session. Attentional functions appear to improve after onset of dialysis treatment as well, but small sample sizes limit the conclusiveness of the data on these cortical processes. Future research efforts should be aimed at correlating physiologic with neuropsychological data and at longitudinal study of intellectual functioning in dialysis patients.

Effects of coping skills training and sertraline in patients with non-cardiac chest pain: a randomized controlled study.

&NA; Non‐cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that psychotropic medication or pain coping skills training (CST) may benefit NCCP patients. To our knowledge, no clinical trials have examined the separate and combined effects of CST and psychotropic medication in the management of NCCP. This randomized clinical trial examined the separate and combined effects of CST and antidepressant medication (sertraline) in participants with non‐cardiac chest pain. A sample of individuals diagnosed with NCCP was randomly assigned to one of four treatments: (1) CST plus sertraline (CST + sertraline), (2) CST plus placebo (CST + placebo), (3) sertraline alone, or (4) placebo alone. Assessments of pain intensity, pain unpleasantness, anxiety, pain catastrophizing, depression, and physical disability were collected prior to treatment, and at 10‐ and 34‐weeks following randomization. Data analyses revealed that CST and sertraline either alone or in combination significantly reduced pain intensity and pain unpleasantness. The combination of CST plus sertraline may have the greatest promise in that, when compared to placebo alone, it not only significantly reduced pain but also pain catastrophizing and anxiety. Overall, these findings support the importance of further research on the effects of CST and sertraline for non‐cardiac chest pain.