Katherine A. Finlay

Music-induced analgesia in chronic pain: Efficacy and assessment through a primary-task paradigm

Research into music-induced analgesia, the ability of music to affect the perception of pain, has under-represented the non-acute, chronic pain population. This longitudinal study aimed to investigate the impact of music listening on chronic pain. In order to extend questionnaire-based approaches of pain assessment, a computerized visual search task was used before and after music listening as an objective measure of pain-related cognitive processing difficulties. Twenty-three participants (chronic pain sufferers or age/gender matched controls) listened to music for 28 days. Questionnaire-based results indicated that music listening consistently reduced pain intensity, unpleasantness and anxiety levels in the short term. However, there were no long-term or cumulative changes in pain relief or anxiety, with participant ratings at baseline comparable to those at 28 days. Visual search task performance demonstrated that chronic pain sufferers showed pain-related cognitive processing inhibitions on the target deviations demanding the greatest processing capacity. This suggests that, though music-induced analgesia was demonstrated through reduced pain ratings, chronic pain continued to interfere with cognitive processing. Durability of music-induced analgesia is therefore likely to be time-limited and hindered by pain-related attentional disruption, reduced engagement and low absorption levels. Explanations of results and suggestions for alternative objective measures of music listening interventions are offered.

Pharmacy care and adherence to primary and secondary prevention cardiovascular medication: a systematic review of studies

Objective To determine if pharmacy service intervention can lead to enhanced adherence to primary and secondary cardiovascular medication and to identify features of interventions that have been found to be effective and feasible. Methods A systematic search of studies related to pharmacy service interventions on adherence and outcomes of cardiovascular diseases was performed using the following databases: PubMed Central UK, PubMed, Cochrane Library, CINHAL, PsycINFO, EMBASE, International Pharmaceutical Abstracts and Google Scholar for the period from 1 January 1990 to 19 November 2013. Trials were included if they were randomised control trials, studies delivered in hospital or community settings, and studies in English language. A hand search of relevant citations was also performed. Key findings Forty-two studies were identified of which 26 had a statistically significant effect on adherence and twenty-seven had a significant effect on clinical outcomes of cardiovascular disease. The interventions included mainly patient education, collaboration between healthcare professionals, use of electronic devices and combined interventions. The interventions were found to be complex and included multiple components. Patient contact with a pharmacist was frequent and thus the interventions may be difficult to adapt to daily practice. Evidence-based data for pharmacy services remain weak but clearly pharmacists can have an impact through face-to-face patient education and telephone consultations. Further research is needed to evaluate the use of a motivational interview in the counselling session of a pharmacist and also to establish the continuity of pharmacy care in primary/secondary setting. Self-reported adherence was the most widely used measure. The acceptable threshold remained 80% among the cardiac population. Conclusion Pharmacist interventions have been shown to be successful in enhancing adherence to cardiovascular medication and improving outcomes of cardiovascular diseases. Whilst pharmacists play a fundamental role in primary and secondary prevention strategies, further randomised controlled trials combining patient education with behaviour change are likely to reap further benefit in medication adherence.

Maximizing self-care through familiarity: The role of practice effects in enhancing music listening and progressive muscle relaxation for pain management

Distraction and relaxation are regularly recommended as part of a pain management toolkit, with increasing research highlighting the inclusion of music as part of pain management toolkit. However, minimal research has assessed the role of practice effects or familiarity with these techniques when used consistently over time. Passive distraction (participant-selected preferred music) and active distraction (Progressive Muscle Relaxation; PMR) were compared against a no distraction control on the cold-pressor test (CPT). Seventy healthy participants completed the CPT with and without distraction at baseline and 1 week later. Experimental participants practised their distraction strategies daily between trials (7 days), with control participants keeping an activity log. Familiarity with and preference for distractors increased significantly over time, enhancing pain threshold. PMR and music reduced anxiety, enhanced pain tolerance, minimized pain perception and pain ratings. The active distraction of PMR enhanced self-efficacy to a greater extent than music and also regulated heart rate. Repeated exposure to distraction and relaxation approaches enhanced optimal arousal and complexity, maximizing pain management. It is suggested that both PMR, and music, are used together as part of a multidimensional toolkit for pain management.

Impact of pharmacy care upon adherence to cardiovascular medicines: a feasibility pilot controlled trial

Objective To investigate the feasibility and potential impact of a pharmacy care intervention, involving motivational interviews among patients with acute coronary syndrome, on adherence to medication and on health outcomes. Methods This article reports a prospective, interventional, controlled feasibility/pilot study. Seventy one patients discharged from a London Heart Attack Centre following acute treatment for a coronary event were enrolled and followed up for 6 months. Thirty two pharmacies from six London boroughs were allocated into intervention or control sites. The intervention was delivered by community pharmacists face-to-face in the pharmacy, or by telephone. Consultations were delivered as part of the New Medicine Service or a Medication Usage Review. They involved a 15–20 min motivational interview aimed at improving protective cardiovascular medicine taking. Results At 3 months, there was a statistically significant difference in adherence between the intervention group (M=7.7, SD=0.56) and the control group (M=7.0, SD=1.85), p=0.026. At 6 months, the equivalent figures were for the intervention group M=7.5, SD=1.47 and for the controls M=6.1, SD=2.09 (p=0.004). In addition, there was a statistically significant relationship between the level of adherence at 3 months and beliefs regarding medicines (p=0.028). Patients who reported better adherence expressed positive beliefs regarding the necessity of taking their medicines. However, given the small sample size, no statistically significant outcome difference in terms of recorded blood pressure and low density lipoprotein-cholesterol was observed over the 6 months of the study. Conclusions The feasibility, acceptability and potentially positive clinical outcome of the intervention were demonstrated, long with a high level of patient acceptability. It had a significant impact on cardiovascular medicine taking adherence. But these findings must be interpreted with caution. The intervention should be tested in a larger trial to ascertain its full clinical utility. Trial registration number ClinicalTrials.gov identifier: NCT01920009.

Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial

Study designBetween-subjects, randomized controlled feasibility study.ObjectivesPopulations with reduced sensory and motor function are at increased risk of depression, anxiety and pain, and may be less geographically mobile. This study explored the efficacy and feasibility of web-based mindfulness training for people with spinal cord injury (SCI).SettingUK community sample.MethodsParticipants were randomly allocated to an 8-week online mindfulness intervention (N = 36), or to internet-delivered psychoeducation (N = 31). Depression symptom severity was the primary outcome. Secondary outcomes included anxiety, quality of life (QoL), pain perception, pain catastrophizing and mindfulness. Measures were taken before (T1), at completion of, (T2), and 3 months following the intervention (T3).ResultsAt T2, ten participants discontinued mindfulness training, and five discontinued psychoeducation. Dropouts were of significantly older age. Nine participants were lost to follow-up. Mindfulness reduced depression significantly more than psychoeducation at T2 (mean difference = −1.50, 95% CI [−2.43, −0.58]) and T3 (mean difference = −2.34, 95% CI [−3.62, −1.10]). Anxiety, pain unpleasantness and catastrophizing were significantly reduced compared with psychoeducation. Total mindfulness scores, and all facets of mindfulness except observing were significantly higher following mindfulness training. At follow-up, reductions in anxiety and catastrophizing persisted.ConclusionsInternet-delivered mindfulness training offers unique benefits and is viable for people with reduced sensory awareness. Future work should explore the feasibility of combined education and mindfulness training. The use of brief interventions shows promise in maximizing participant retention.

Developing successful social support: An interpretative phenomenological analysis of mechanisms and processes in a chronic pain support group

Objective: The experience of long-term membership of a successful chronic pain support group (CPSG) was explored to identify; (i) factors associated with social support, and; (ii) ways that health care professionals (HCPs) could help CPSGs become more effective and supportive. Design: Interpretative Phenomenological Analysis enabled exploration of participants’ experiences of membership and rationales for continued attendance. Main outcome measures: Twelve participants (four males, eight females), recruited from a regional CPSG, completed semi-structured interviews lasting from 45 to 120 minutes. Following verbatim transcription, idiographic then cross-case analyses were undertaken. Results: Three superordinate themes emerged: (1) Investing in the new normal; (2) The nurturing environment; (3) Growth facilitation through social evolution. Increased investment and identification with membership, generated snowballing social engagement, enhancing pain management/well-being through collective humour and peer-to-peer support. Explicit guidance by HCPs in early stages of group formation/development, and subsequent implicit influences on group attitudes and actions, promoted the group’s development into its current healthy, supportive state. Conclusion: Contrary to stereotypes, membership offered positive respite from chronic pain through collective coping. Successful CPSGs forge an independent identity, fostering strong group investment and an ability to live well with chronic pain. HCPs can provide a stabilising foundation for CPSGs to develop positively and supportively.

Efficacy of internet-delivered mindfulness for improving depression in caregivers of people with spinal cord injuries and chronic neuropathic pain; A randomized controlled feasibility trial

OBJECTIVES To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI). DESIGN Randomized controlled feasibility study with 3-month follow-up. SETTING Community setting. PARTICIPANTS Spouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via the direct care team and advertisements. Participants were older than 18 years (no upper age limit), with Internet access for the duration of the study. Participants were randomly allocated to an 8-week online mindfulness training intervention (n=28), or to receive 8 weeks of psychoeducational materials on SCI and chronic pain (n=27). INTERVENTIONS An established web-based, mindfulness training course was delivered over 8 weeks. Participants completed 10 minutes of mindfulness practices, twice per day, 6 days per week, totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks. MAIN OUTCOME MEASURE Depression severity. RESULTS Mindfulness reduced depression severity more than psychoeducation at T2 (mean difference= -.891; 95% confidence interval,-1.48 to -.30) and T3 (mean difference=-1.96; 95% confidence interval, -2.94 to -.97). Mindfulness training also reduced anxiety at T2 (mean difference=-.888; 95% confidence interval, -1.40 to -.38) and T3 (mean difference=-2.44; 95% confidence interval, -3.20 to -1.69). CONCLUSIONS Results indicate that Internet-delivered mindfulness training offers unique benefits and is viable for caregivers of people with SCI and chronic neuropathic pain. Further work should explore the feasibility of combined education and mindfulness training incorporating both patient and caregiver, for optimum benefit.

Neuropathic pain in a rehabilitation setting after spinal cord injury: an interpretative phenomenological analysis of inpatients’ experiences

Study designQualitative, semi-structured interviews.ObjectivesNeuropathic pain (NP) can be psychologically and physically debilitating, and is present in approximately half of the spinal cord injured (SCI) population. However, under half of those with NP are adherent to pain medication. Understanding the impact of NP during rehabilitation is required to reduce long-term impact and to promote adherence to medication and psychoeducation recommendations.SettingUnited Kingdom.MethodsFive males and three females with SCI and chronic NP, resident in rehabilitation wards at a specialist SCI center in the United Kingdom, took part. Semi-structured interviews were conducted with participants less than 15 months post-SCI (mean = 8.4 months). Verbatim transcripts were subject to interpretative phenomenological analysis (IPA).ResultsThree super-ordinate themes were identified, mediating pain and adherence: (1) the dichotomy of safety perceptions; (2) adherence despite adversity; and (3) fighting the future. Analyses suggest that experience of the rehabilitation setting and responsiveness of care shapes early distress. Attitudes to medication and psychosocial adjustment are relevant to developing expectations about pain management.ConclusionsEnhancing self-efficacy, feelings of safety in hospital, and encouraging the adoption of adaptive coping strategies may enhance psychosocial and pain-related outcomes, and improve adherence to medication. Encouraging adaptive responses to, and interpretation of, pain, through the use of interventions such as coping effectiveness training, targeted cognitive behavioral pain management, and acceptance-based interventions such as mindfulness, is recommended in order to reduce long-term reliance on medication.