Helen Poole

Depression in Chronic Pain Patients: Prevalence and Measurement

This study aimed to: (1) determine prevalence of depression in patients referred to specialist pain services using the Structured Clinical Interview (SCID) diagnostic interview, (2) compare results on the Beck Depression Inventory II (BDI‐II) with the SCID to determine the utility of the BDI‐II as a screening tool in this population.

Maternal parenting stress and its correlates in families with a young child with cerebral palsy

OBJECTIVE To investigate factors predicting parenting stress in mothers of pre-school children with cerebral palsy. METHOD Eighty mothers and children participated. Mothers completed the Parenting Stress Index (PSI) and the following measures of family functioning: family support, family cohesion and adaptability, coping strategies, family needs and locus of control. Children were assessed using the Griffiths Scales and the Gross Motor Function measure. The childs home environment was assessed using Home Observation for Measuring the Environment. RESULTS Mothers had higher mean total PSI scores than the means for the typical sample; 43% had total PSI scores above the threshold for clinical assessment. Cluster analysis demonstrated five distinct clusters of families, more than half of whom were coping well. High stress items were role restriction, isolation and poor spouse support, and having a child who was perceived as less adaptable and more demanding. Lower stress items indicated that this sample of mothers found their children emotionally reinforcing and had close emotional bonds. Regression analysis showed that the factors most strongly related to parenting stress levels were high family needs, low family adaptability and cognitive impairment in the child. CONCLUSIONS The results confirmed the individuality of families, and that individual characteristics of coping and feeling in control, together with family support and cohesion, are associated with variation in amount of stress experienced in parenting a child with cerebral palsy.

Factor Structure of the Beck Depression Inventory-II in patients With chronic pain.

ObjectivesTo examine the factor structure of the Beck Depression Inventory version II (BDI-II) in patients seeking treatment for chronic pain, using exploratory and confirmatory factor analysis and provide comparative data for use with similar patient populations. In addition, to consider the utility of using BDI-II subscale scores to further inform the management of patients with chronic pain. MethodsPhase I involved analysis of responses to the BDI-II by 1227 patients assessed for a pain management program. The sample data was split into 2 halves. A series of exploratory factor analyses on the first half suggested 2 factors. Confirmatory factor analysis was then used on the second half to confirm goodness-of-fit for this 2-factor solution and compare with a 1-factor solution and factor models presented in the BDI-II handbook derived on student and psychiatric outpatient populations. Comparison was also made of derived factor scores between this pain clinic sample and the normative psychiatric outpatient and student samples. In the second phase, longitudinal data on a further 269 patients who had completed the pain management program was used to examine the amount of variance in pain and disability outcomes accounted for by total BDI-II and 2-factor subscale scores at assessment. ResultsTwo correlated factors incorporating 18 items from the BDI-II gave good goodness-of-fit (0.916). Factor 1 loaded heavily onto negative cognitions about the self plus mood symptoms, factor 2 onto changes in behavior and activity plus low mood. Summed scores on factor 1 from pain clinic patients were very significantly lower than for psychiatric outpatients, indicating less negative cognitions about the self, and very significantly higher than for a student sample. Pain clinic patient scores on factor 2 were very significantly higher than those for both psychiatric outpatients and students, indicating more reporting of behavior change and affective symptoms. Subscale scores accounted for a small but significant amount of variance in both pain and disability at follow-up, with each scale predicting in opposite directions. Total BDI-II scores predicted similar amounts of variance in disability at follow-up, but were not significantly associated with pain at follow-up. DiscussionResults are consistent with studies using previous versions of the BDI in suggesting that 2-factor scores may be more clinically useful in the assessment of patients referred with chronic pain.

The utility of the Beck Depression Inventory Fast Screen (BDI-FS) in a pain clinic population.

This study compared the BDI‐FS to the BDI‐II in a sample of patients with chronic pain. The objectives were to: look at agreement between measures, determine BDI‐FS cut‐off scores, develop a conversion formula, consider the usefulness of the suicide ideation item and compare ability to detect clinical change. Phase I: Archival data from 1227 patients assessed for a pain management programme was analysed. The BDI‐FS displayed good internal consistency (α=.839). ROC curve analysis showed good agreement between the BDI‐II and FS and suggested a BDI‐FS cut‐off of four corresponded to the 19 cut‐off recommended in the BDI‐II manual. We recommend a cut‐off of five to correspond to a BDI‐II cut‐off of 22 for pain clinic patients recommended by previous research. Regression suggested BDI‐II score=(2.77×BDI‐FS score)+9.14. Our data support the clinical usefulness of the suicide ideation item in this population. Phase II: Archival data from 584 patients collected at baseline, following a 16 day pain management programme and at 6 months follow‐up, was analysed. Effect sizes indicated equivalent sensitivity to clinical change. The BDI‐FS showed good psychometric properties, strong agreement with the BDI‐II and equal ability to detect clinical change in a pain clinic population. The BDI‐FS has the practical advantages of faster administration and reduced patient burden.

A randomised controlled study of reflexology for the management of chronic low back pain

The use of complementary and alternative medicine (CAM) for the management of chronic low back pain (CLBP) continues to rise. However, questions regarding the efficacy of many CAM therapies for CLBP remain unresolved. The present study investigated the effectiveness of reflexology for CLBP. A pragmatic randomised controlled trial was conducted. N=243 patients were randomised to one of three groups: reflexology, relaxation, or non‐intervention (usual care). All completed a questionnaire booklet before and after the treatment phase, and at six months follow up. This measured their general health status, pain, functioning, coping strategies and mood. After adjusting for pre‐treatment scores repeated measures ANCOVA found no significant differences between the groups pre and post treatment on the primary outcome measures of pain and functioning. There was a main effect of pain reduction, irrespective of group. Trends in the data illustrated the pain reduction was greatest in the reflexology group. Thus, the current study does not indicate that adding reflexology to usual GP care for the management of CLBP is any more effective than usual GP care alone.

Development and Preliminary Validation of the NePIQoL: A Quality-of-Life Measure for Neuropathic Pain

Neuropathic pain is frequently associated with negative effects on quality of life (QoL), affecting physical, social, and psychological functioning. Of many existing scales used to measure QoL, none have been validated in a neuropathic pain patient population. This study reports on the development and preliminary psychometric evaluation of the Neuropathic Pain Impact on Quality-of-Life questionnaire (NePIQoL), a measure to assess QoL in neuropathic pain. In Phase I, focus groups with 27 patients and a panel of experts identified QoL issues for inclusion in the measure. Initial items (152) and response categories were pretested using cognitive interviewing (18 patients). Following this, the number of items was reduced to 91. In Phase II, the 91-item version of the NePIQoL was administered to a further 112 patients, poorly performing items were identified, and internal consistency was examined. In Phase III, the revised NePIQoL was administered to a further 110 patients on two occasions to examine validity and test-retest reliability. Qualitative and quantitative pretesting led to extensive revision, resulting in a final measure of 42 items. Finally, Phase IV tested the concurrent validity and responsiveness of the NePIQoL. The authors conclude that the NePIQoL is an acceptable, patient-derived, neuropathic pain-specific measure with evidence of reliability, validity, and temporal stability.

Repetitive transcranial magnetic stimulation over primary motor vs non-motor cortical targets; effects on experimental hyperalgesia in healthy subjects

BackgroundHigh frequency repetitive transcranial magnetic stimulation (rTMS) targetted to different cortical regions (primary motor/sensory, prefrontal) are known to alter somatosensory responses. The mechanism(s) for these effects are unclear. We compared the analgesic effects of rTMS at different cortical sites on hyperalgesia induced using topical capsaicin cream.MethodsFourteen healthy subjects had capsaicin cream applied to a 16 cm2 area of the medial aspect of the right wrist (60 min) on 4 separate occasions over 6 weeks. rTMS (10Hz for 10s/min = 2000 stimuli @ 90% resting motor threshold of first dorsal interosseus muscle) was applied to the optimum site for right hand (M1), left dorsolateral prefrontal (DLFPC) and occipital midline (OCC) in a pseudo-randomised order. Thermal and mechanical perception and pain thresholds were determined using standardised quantitative sensory testing (QST) methods at the capsaicin site. Subjective responses to thermal stimuli (pain score on a numerical rating scale) from −2.5°C to +2.5°C of the individualised heat pain threshold (HPT) resulted in a hyperalgesia curve. Sensory testing took place prior to capsaicin application (PRE-CAP), after 30 min of capsaicin (POST-CAP) and following rTMS (30 min = POST-TMS).ResultsCapsaicin application resulted in substantial changes in thermal (but not mechanical) sensitivity to both heat and cold (eg. HPT PRE-CAP = 43.6°C to POST-CAP = 36.7°C (p < 0.001)) with no differences between groups pre-rTMS. POST-TMS HPT showed no changes for any of the treatment groups, however the pain scores for the hyperalgesia curve were significantly lower for M1 vs OCC (−24.7%, p < 0.001) and for M1 vs DLFPC (−18.3%, p < 0.02).ConclusionrTMS over the primary motor cortex results in a significant analgesic effect compared to other cortical areas.

Patients' experiences of living beyond colorectal cancer: A qualitative study

PURPOSE OF THE RESEARCH This paper is a report of a study of the experiences of individuals with colorectal cancer in the period following their cancer treatment and the physical, psychological and social aspects associated with adjusting to everyday life. METHODS AND SAMPLE Qualitative interviews using a phenomenological approach were conducted with a purposive sample of 13 individuals who had completed active curative treatment for colorectal cancer. RESULTS Study findings suggest that colorectal cancer survivors employ a broad range of techniques and approaches to manage adjustment to everyday life such as goal-setting, managing informal networks and adopting strategies for physical and emotional recovery. Personal interests were used to create a sense of meaning and through the cultivation of altruistic and utilitarian outlooks on life, positive emotional gains were obtained. CONCLUSIONS Colorectal cancer survivors employ personal strategies for managing life in the survivorship period following cancer treatment. The study findings demonstrate additional areas for exploration such as the effect of altruism on adjustment and the relationship to other groups of cancer survivors.

A cognitive-perceptual model of symptom perception in males and females: The roles of negative affect, selective attention, health anxiety and psychological job demands

Kolk et al.’s model of symptom perception underlines the effects of trait negative affect, selective attention and external stressors. The current study tested this model in 263 males and 498 females from an occupational sample. Trait negative affect was associated with symptom reporting in females only, and selective attention and psychological job demands were associated with symptom reporting in both genders. Health anxiety was associated with symptom reporting in males only. Future studies might consider the inclusion of selective attention, which was more strongly associated with symptom reporting than negative affect. Psychological job demands appear to influence symptom reporting in both males and females.

Measuring the impact of long-term medicines use from the patient perspective.

Polypharmacy is increasing, seemingly inexorably, and inevitably the associated difficulties for individual patients of coping with multiple medicines rise with it. Using medicines is one aspect of the burden associated with living with a chronic condition. It is becoming increasingly important to measure this burden particularly that relating to multiple long-term medicines. Pharmacists and other health professionals provide a myriad of services designed to optimise medicines use, ostensibly aiming to help and support patients, but in reality many such services focus on the medicines, and seek to improve adherence rather than reducing the burden for the patient. We believe that the patient perspective and experience of medicines use is fundamental to medicines optimisation and have developed an instrument which begins to quantify these experiences. The instrument, the Living with Medicines Questionnaire, was generated using qualitative findings with patients, to reflect their perspective. Further development is ongoing, involving researchers in multiple countries.