G.J. Versteegen

Mindfulness, acceptance and catastrophizing in chronic pain.

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.

Pain‐related catastrophizing in pain patients and people with pain in the general population

Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non‐clinical pain. The aim of the present study is to investigate levels of catastrophizing in pain patients and people with pain from the general population. Also, the relationship between catastrophizing and pain intensity, specialist consultation and use of pain medication is studied.

Chronic pain and severe disuse syndrome : long-term outcome of an inpatient multidisciplinary cognitive behavioural programme

OBJECTIVE Patients with chronic pain and severe disuse syndrome have pain with physiological, psychological and social adaptations. The duration and severity of complaints, combined with previously failed treatments, makes them unsuitable for treatment in primary care. DESIGN A prospective waiting list controlled study. PATIENTS A total of 32 patients with chronic pain for at least one year and severe disuse syndrome were included in an inpatient multidisciplinary cognitive behavioural treatment. METHODS Patients were assessed before the waiting list period, before the clinical phase, after the clinical phase and after follow-ups of 6 months and one year. The visual analogue scale for pain and fatigue were assessed. Muscle strength of the arms and legs, arm endurance and a 6-minute walking test were used to assess physical outcome. The Symptom Checklist-90, RAND-36, pain cognition list and the Tampa scale for kinesiophobia were used to assess psychological outcome. RESULTS Long-term significant (p < 0.001) improvements were found for pain, fatigue, walking distance, muscle strength, anxiety, depression, somatization, negative self-efficacy, and catastrophizing in the intervention period. CONCLUSION An inpatient multidisciplinary cognitive behavioural programme is beneficial for patients with chronic pain and a severe disuse syndrome.

Sprain of the neck: quality of life and psychological functioning. A 4-year retrospective study.

Aim of the study was to analyse quality of life and psychological functioning in patients with sprain of the neck, to analyse the relationship between complaints, quality of life, psychological functioning and personality factors, and to analyse the profile of patients with whiplash associated disorders (WAD), 4 years after trauma. From the University Hospital Groningen 193 patients with the diagnose sprain of the neck filled out a questionnaire. Of this group 100 subjects did not have complaints before the accident and were therefore at risk for the development of complaints as a result of sprain of the neck. Quality of life and psychological functioning were assessed using the RAND-36 and the SCL-90, respectively. Personality was assessed by means of the Dutch Personality Questionnaire. Of the group at risk (56% women and 44% men, mean age: 33.9, SD: 14.6) quality of life was significantly worse in subjects with complaints (mean: 78.4, SD: 15.5) compared to subjects without complaints (mean: 87.5, SD: 8.7). Psychological functioning did not differ significantly between the group with complaints compared to group without complaints. Personality did not differ between the groups. Personality and complaints together were significantly related to quality of life (r: 0.77) and psychological functioning (r: 0.85). No specific profile of WAD patients was found. In conclusion, personality and complaints influence quality of life and psychological functioning to a considerable extent.

A randomized controlled trial of an Internet-based cognitive–behavioural intervention for non-specific chronic pain: An effectiveness and cost-effectiveness study

Cognitive–behavioural treatment can nowadays be delivered through the Internet. This form of treatment can have various advantages with regard to availability and accessibility. Previous studies showed that Internet‐based treatment for chronic pain is effective compared to waiting‐list control groups.

Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity: Rehabilitation process and prosthetics. Part 2

Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis fitting and the use of replacement parts. Objectives: To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 2 focuses on rehabilitation process and prosthetics. Study design: Systematic literature design. Methods: Literature search in five databases and quality assessment on the basis of evidence-based guideline development. Results: An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity. Conclusion: The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for treatment and reintegration of patients undergoing amputation of a lower extremity and can be used to provide patient information. Clinical relevance This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice.

Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity: Amputation surgery and postoperative management. Part 1

Background: Surgeons still use a range of criteria to determine whether amputation is indicated. In addition, there is considerable debate regarding immediate postoperative management, especially concerning the use of ‘immediate/delayed fitting’ versus conservative elastic bandaging. Objectives: To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 1 focuses on amputation surgery and postoperative management. Study design: Systematic literature design. Methods: Literature search in five databases. Quality assessment on the basis of evidence-based guideline development. Results: An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity. Conclusion: The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for diagnosis, referral, assessment, and undergoing amputation of a lower extremity and can be used to provide patient information. Clinical relevance This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice.

A randomized controlled trial of an Internet-based cognitive-behavioural intervention for non-specific chronic pain: An effectiveness and cost-effectiveness study: Internet-based cognitive-behavioural intervention

Cognitive–behavioural treatment can nowadays be delivered through the Internet. This form of treatment can have various advantages with regard to availability and accessibility. Previous studies showed that Internet‐based treatment for chronic pain is effective compared to waiting‐list control groups.

A randomized controlled trial of an Internet-based cognitive-behavioural intervention for non-specific chronic pain

Cognitive–behavioural treatment can nowadays be delivered through the Internet. This form of treatment can have various advantages with regard to availability and accessibility. Previous studies showed that Internet‐based treatment for chronic pain is effective compared to waiting‐list control groups.

859 LONG TERM OUTCOME OF A CLINICAL MULTIDISCIPLINARY COGNITIVE‐BEHAVIORAL PROGRAM FOR INCAPACITATING CHRONIC PAIN OF LONG DURATION

Background and Aims: Patients with chronic incapacitating pain of long duration are a challenge for healthcare professionals. The purpose of this study was to analyze the effects of individual clinical cognitive behavioral therapy (CBT) in this patient group. Methods: After multidisciplinary assessment patients who matched the inclusion criteria were included in a CBT. Patients were measured before waiting list, before and after clinical CBT and after a half years and a years follow up. The clinical CBT treatment team consisted of a psychologist, a physical therapist and a physician. Measured were: symptoms (pain, fatigue) psychological outcome (SCL 90, Pain cognition list, Tampa scale) Quality of Life (SF-36) and physical outcome (6 minutes walking distance, arm endurance, strength upper and lower limbs). A non parametric T-test was applied. Results: In this prospective waiting list controlled study 26 patients were included. All patients had pain in more than one body part. The mean pain duration was 8 years (sd 7) Patients had visited 5 (mean, sd 2) medical specialists for their pain. No differences were found during the waiting list period. Significant effects (p< 0.001) were found on symptoms (pain, fatigue), psychological outcome (anxiety, depression, somatisation, catastrophizing, negative self efficacy, kinesiophobia), physical functioning, general health perception and physical outcome (walking distance, strength) during the clinical CBT, these effects were maintained at the one years follow up. Conclusions: An individual clinical CBT breaks the vicious circle of pain in patients with incapacitating long lasting chronic pain and showed long term effects.