Gabriel Tan

Irritable bowel syndrome and dyspepsia among women veterans: prevalence and association with psychological distress

Backgroundu2002 The burden of functional GI disorders and their associations with psychological distress in women veterans is unclear.

Adaptive versus maladaptive coping and beliefs and their relation to chronic pain adjustment.

ObjectivesCoping and beliefs are cornerstones to our understanding of adjustment to chronic pain. This study sought to test the hypothesis that maladaptive pain-related coping and beliefs are more strongly related to measures of patient adjustment than are adaptive coping and beliefs. MethodsA sample of 106 veterans with mixed chronic pain diagnoses in a multidisciplinary pain treatment program were administered measures of pain beliefs and pain coping, and composite scores were computed to reflect adaptive and maladaptive responses. Correlations between the composite scores and outcomes (pain intensity, pain interference, depression) were examined. Hierarchical multiple regressions were also conducted to estimate the independent contributions of adaptive and maladaptive responses. ResultsThe maladaptive response composite score was found to be significantly related to pain interference and depression, whereas both adaptive and maladaptive response composite scores were found to be significantly related to pain intensity. The maladaptive response composite showed stronger independent associations with pain interference and depression after controlling for demographic variables, pain intensity, and adaptive responses. Contrary to expectations, only the adaptive response composite showed an independent association with pain intensity. DiscussionThe findings suggest that the relative importance of adaptive versus maladaptive beliefs and coping may differ as a function of the outcome domain in question. The findings support current cognitive-behavioral interventions that focus on reducing the frequency of maladaptive coping responses and beliefs as a way to improve patient functioning.

Improving Access to Care for Women Veterans Suffering from Chronic Pain and Depression Associated with Trauma

OBJECTIVEnAccess to care has become a priority for the Veterans Administration (VA) health care system as a significant number of veterans enrolled in the VA health care system reside in rural areas. The feasibility and effects of a novel clinical intervention that combined group therapy and biofeedback training was evaluated on women veterans living in rural areas.nnnMETHODSnThe study was conducted at selected community-based outpatient clinics (CBOCs) in Texas. Thirty four women veterans with chronic pain and comorbid depression and/or posttraumatic stress disorder (PTSD) were recruited. Five sessions of education/therapy were delivered via telemedicine in combination with daily home practice of a portable biofeedback device (Stress Eraser®, Helicor, New York, NY, USA). Participants responded to self-report questionnaires at baseline, at posttreatment, and at 6-week follow-up. Daily practice logs were also maintained by participants.nnnRESULTSnThe clinical protocol was acceptable, easy to administer, and associated with statistically significant decreases in self-reported pain unpleasantness, pain interference, depressive symptoms, PTSD symptoms, and sleep disturbance at posttreatment. Improvements were maintained at 6-week follow-up. Qualitative analyses indicated that many participants 1) wished to continue to meet as a support group in their respective CBOCs and 2) felt less isolated and more empowered to cope with their problems of daily living as a result of the treatment.nnnCONCLUSIONSnIt is feasible to provide treatment to women veterans living in rural areas by utilizing video-teleconferencing technology between larger VA medical centers and facilities at CBOCs in more rural settings. A controlled trial of the intervention is warranted.

Pain Intensity, Headache Frequency, and the Behavioral Activation and Inhibition Systems.

Objectives:To test the hypothesized associations between measures of the behavioral inhibition system (BIS) and behavioral activation system (BAS) and both the intensity and frequency of pain. Methods:A total of 563 college students were administered measures of BIS and BAS and asked to indicate both (1) the average intensity of pain at 10 body sites during the past week and (2) the frequency with which they experience mild, moderate, and severe headaches. The associations between (1) the BIS and BAS scale scores and (2) the worst average pain intensity experienced and headache frequencies were examined using a series of 1-way analyses of variance. Results:As predicted, the measure of BIS demonstrated significant and nonlinear associations with both pain intensity and headache frequency. The measure of BAS was not significantly related to pain intensity, but did demonstrate a nonlinear association with the frequency of severe headaches. Discussion:The findings are consistent with predictions based on a model hypothesizing that pain has a nonlinear impact on both BIS and BAS, with a stronger impact on BIS than BAS. If the current results are replicated in other samples, including samples of individuals with chronic pain, they have important implications for identifying biological factors that could influence pain and behavioral responses to pain, as well as for the development and evaluation of treatments that could enhance positive treatment outcomes.

The buffering role of positive affect on the association between pain intensity and pain related outcomes

Abstract Objectives Chronic pain is a significant problem worldwide and is associated with significant elevations in negative affect, depressive symptoms, sleep problems, and physical dysfunction. Positive affect could potentially buffer the impact of pain on patient functioning. If it does, then positive affect could be directly targeted in treatment to benefit individuals with chronic pain. The purpose of this study was to test for such moderating effects. Methods This was a cross-sectional study, we administered measures of pain intensity, depressive symptoms, sleep problems, pain interference, and positive and negative affect to 100 individuals with chronic back or knee pain in a single face-to-face assessment session. Results The associations between pain intensity and negative affect, and between pain intensity and depressive symptoms were moderated by positive affect. This moderation effect was explained by the fact that participants with low positive affect evidenced strong associations between pain intensity and both depression and negative affect; participants with high positive affect, on the other hand, evidenced weak and non-significant associations between pain intensity and both depression and negative affect. Positive affect did not moderate the associations between pain intensity and either sleep problems or pain interference. Conclusion The findings are consistent with the possibility that positive affect may buffer the impact of pain intensity on negative affect and depressive symptoms. Longitudinal and experimental research is needed to determine the potential benefits of treatments that increase positive affect on negative affect and depressive symptoms in chronic pain populations. Implications The study findings suggest the possibility that “positive psychology” interventions which increase positive affect could benefit individuals with chronic pain by reducing the impact of pain on negative outcomes. Research to test this possibility is warranted.

Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society

BackgroundThis study explores differences in characteristics of overdose (OD) and non-overdose (NOD) suicide attempts in Singapore.MethodsFour hundred eighty-five medical records of people who attempted suicide were extracted from a local general hospital patient database and classified into OD and NOD groups. Differences in socio-demographic factors, suicide characteristics and hospital admission types between both groups were examined.ResultsIndians were more likely than the Chinese and Malays to employ OD method in their attempts. More suicide attempts in the OD group than NOD group were self-reported. The most likely place for suicide attempts for both groups was at home, though more NOD suicide attempts were in public areas as compared to the OD group. Analgesics were the most used substance in the OD group. Those who attempted suicide using OD had a higher number of psychiatric ward admissions than the NOD group. Risk and protective factors varied between both groups.ConclusionDifferences in socio-demographics, suicide characteristics and admission characteristics between OD and NOD groups were observed. Recommendations for suicide prevention in the community are discussed. Further studies on the mediators and moderators of these trends and characteristics of suicide attempts are necessary to ensure maximal efficacy of prevention and management.

Anxiety Sensitivity and Depression: Explaining Posttraumatic Stress Disorder Symptoms in Female Veterans With Chronic Pain

Female veterans report more severe levels of chronic pain and posttraumatic stress disorder (PTSD) symptoms than their male counterparts. Researchers have postulated that these conditions can mutually maintain each other. The current study tested whether anxiety sensitivity and depression account for the association between chronic pain and PTSD symptoms in a sample of female veterans (N = 42) with chronic pain. We found that pain unpleasantness, anxiety sensitivity, and depression all predict PTSD symptoms. As hypothesized, anxiety sensitivity and depression emerged as unique predictors of PTSD symptoms when simultaneously entered into the model with pain unpleasantness. Clinical implications are discussed.

Integrative Approaches to Orofacial Pain: Role of Biofeedback and Hypnosis

EMG biofeedback procedures in which patients are shown their levels of masticatory muscle tension and taught to recognize and then control tension levels is a highly effective way to treat muscle tension-based orofacial pain. n n nBiofeedback-based interventions are at least as effective as traditional dental and medical therapeutic approaches for muscle related pain and may last indefinitely. n n nBiofeedback for recognizing and then controlling sustained levels of jaw muscle tension works best when patients learn the skills thoroughly and then continue to practice them. n n nPatients will probably benefit most by consulting with well-skilled and appropriately credentialed biofeedback providers [21]. n n nHypnosis and hypnotherapy could also contribute to management of the orofacial pain by adding the elements of altering pain perception and experience, and improving motivation to respond to treatment. n n nAcquisition and maintenance of a low level generalized relaxation state is counter to the experience of TMD pain.

Factors Contributing towards Stigmatisation of Offenders in Singapore

Stigmatisation is a frequently listed as a concern by offenders and has been identified as a major barrier to reintegration. The present study explored factors contributing to stigmatising attitudes towards various sub-types of offenders in Singapore. Six hundred and twenty-eight undergraduate students read a vignette illustrating a sexual, a white-collar, or a violent crime before answering various questionnaires in an online survey. Previous contact with offenders was not related to desire for social distance from them. However, respondents who perceived offenders as incapable of changing, as well as those who felt more morally outraged by the crimes they had committed, indicated a greater desire for social distance from offenders. Respondents also had a tendency to desire distance from sexual and violent offenders more than they did from white-collar offenders. The findings extend the understanding of pathways leading towards stigmatisation of offenders and have implications for policy-making and reintegration efforts.

A Comparison of Pain Beliefs and Coping Strategies and Their Association with Chronic Pain Adjustment Between Singapore and United States.

ObjectivesnResearch examining the importance of pain beliefs and coping strategies to chronic pain adjustment has been performed almost exclusively using Western populations. The purpose of this study was to examine empirically the generalizability of this research to Singapore.nnnMethodsnEmploying a cross-sectional design, measures assessing pain beliefs, coping strategies, pain intensity, pain interference, and depressive symptoms were administered to 101 patients with chronic pain from Singapore. Analyses examined the means of belief and coping strategies measures and their associations with measures of pain intensity, pain interference, and depressive symptoms and compared the results with the data of a sample of 100 patients with chronic pain from a previously published study from the United States.nnnResultsnMean differences between the Singapore and US samples were found for four of the seven belief scales, and four of the eight coping scales. When significant, associations between belief and coping strategies with measures of pain and dysfunction were in the hypothesized directions in both samples. We also found that the strength of four out of 30 of the associations between beliefs/coping strategies and measures of pain and dysfunction were different between the Singapore and US samples.nnnConclusionnThe findings provide further support for the potential influence of culture on how individuals view and cope with pain. However, the many similarities found in direction and strength of the associations between beliefs/coping strategies and measures of pain/dysfunction provide preliminary support for the appropriateness of the use of cognitive behavioral therapy developed in the United States with the Singapore population.