Malcolm H. Johnson

The outcome of complex regional pain syndrome type 1: a systematic review.

UNLABELLED The purpose of this systematic review was to examine the outcome of complex regional pain syndrome (CRPS) type 1. We searched MEDLINE, Embase, and PsycINFO for relevant studies and included 18 studies, with 3,991 participants, in this review. The following data were extracted: study details, measurement tools used, and rates or severity scores for the symptoms/signs of CRPS at baseline and follow-up, or in groups of patients with different disease durations. A quality assessment revealed significant limitations in the literature, with many studies using different diagnostic criteria. The 3 prospective studies demonstrated that for many patients, symptoms improve markedly within 6 to 13 months of onset. The 12 retrospective studies had highly heterogeneous findings, documenting lasting impairments in many patients. The 3 cross-sectional studies showed that rates of pain and sensory symptoms were highest among those with the longest duration of CRPS. Additionally, most studies showed that motor symptoms (stiffness and weakness) were the most likely to persist whereas sudomotor and vasomotor symptoms were the most likely to improve. Overall, this suggests that some CRPS patients make a good early recovery whereas others develop lasting pain and disability. As yet little is known about the prognostic factors that might differentiate between these groups. PERSPECTIVE We found evidence that many CRPS patients recover within 6 to 13 months, but a significant number experience some lasting symptoms, and some experience chronic pain and disability. The quality of the evidence was poor. Future research should examine the factors associated with recovery and identify those at risk of poor outcomes.

Kindness Matters: A Randomized Controlled Trial of a Mindful Self-Compassion Intervention Improves Depression, Distress, and HbA1c Among Patients With Diabetes

OBJECTIVE Mood difficulties are common among patients with diabetes and are linked to poor blood glucose control and increased complications. Evidence on psychological treatments that improve both mood and metabolic outcomes is limited. Greater self-compassion predicts better mental and physical health in both healthy and chronically ill populations. Thus, the purpose of this randomized controlled trial (RCT) was to evaluate the effects of self-compassion training on mood and metabolic outcomes among patients with diabetes. RESEARCH DESIGN AND METHODS This RCT tested the effects of a standardized 8-week mindful self-compassion (MSC) program (n = 32) relative to a wait-list control condition (n = 31) among patients with type 1 and type 2 diabetes. Measures of self-compassion, depressive symptoms, diabetes-specific distress, and HbA1c were taken at baseline (preintervention), at week 8 (postintervention), and at 3-month follow-up. RESULTS Repeated-measures ANOVA using intention to treat showed that MSC training increased self-compassion and produced statistically and clinically significant reductions in depression and diabetes distress in the intervention group, with results maintained at 3-month follow-up. MSC participants also averaged a clinically and statistically meaningful decrease in HbA1c between baseline and follow-up of >10 mmol/mol (nearly 1%). There were no overall changes for the wait-list control group. CONCLUSIONS This initial report suggests that learning to be kinder to oneself (rather than being harshly self-critical) may have both emotional and metabolic benefits among patients with diabetes.

Do psychological factors influence recovery from complex regional pain syndrome type 1? A prospective study.

Abstract Previous studies have shown that the outcomes of complex regional pain syndrome (CRPS) vary significantly between patients, but few studies have identified prognostic indicators. The aim of this study was to determine whether psychological factors are associated with recovery from recently onset CRPS amongst patients followed prospectively for 1 year. Sixty-six patients with CRPS (type 1) were recruited within 12 weeks of symptom onset and assessed immediately and at 6 and 12 months, during which time they received treatment as usual. At each assessment, the following were measured: signs and symptoms of CRPS, pain, disability, depression, anxiety, stress, pain-related fear, pain catastrophising, laterality task performance, body perception disturbance, and perceived ownership of the limb. Mixed-effects models for repeated measures were conducted to identify baseline variables associated with CRPS severity, pain, and disability over the 12 months. Results showed that scores for all 3 outcome variables improved over the study period. Males and those with lower levels of baseline pain and disability experienced the lowest CRPS severity scores over 12 months. Those with lower baseline anxiety and disability had the lowest pain intensity over the study period, and those with lower baseline pain and pain-related fear experienced the least disability over the 12 months. This suggests that anxiety, pain-related fear, and disability are associated with poorer outcomes in CRPS and could be considered as target variables for early treatment. The findings support the theory that CRPS represents an aberrant protective response to perceived threat of tissue injury.

Marathon runners' reaction to potassium iontophoretic experimental pain: pain tolerance, pain threshold, coping and self-efficacy.

There is equivocal evidence regarding pain responding in endurance athletes. When performing, their pain experience appears reduced but it is uncertain whether this persists when not competing or training. This study aimed to clarify how marathon runners perceive pain, and the influence of self‐efficacy and coping strategy use on their pain threshold and tolerance when they are not affected by immediate exercise. Pain threshold and pain tolerance were assessed in 26 marathon runners and 26 age‐ and sex‐matched non‐runners using potassium iontophoresis as the experimental pain stimulus. Use of associative and dissociative coping strategies, and catastrophizing were assessed using the Cognitive Coping Strategies Inventory, and pain specific and general self‐efficacy were measured. Elevated pain threshold, pain tolerance and self‐efficacy in marathon runners were revealed. Pain specific self‐efficacy accounted for 40% of the tolerance difference between the marathon and non‐marathon groups. Coping and catastrophizing did not differ between the two groups but higher associative coping when accompanied by lower dissociative coping was related to higher pain tolerance. These results indicate that marathon runners have a reduced experience of pain compared with non‐runners. This ability appears to be augmented by a high level of pain specific self‐efficacy but is unaffected by the influence of general cognitive coping strategies, although higher associative coping and lower dissociative coping together were related to reduced pain tolerance independent of running involvement.

Extent of recovery in the first 12 months of complex regional pain syndrome type‐1: A prospective study

The literature concerning the outcomes of complex regional pain syndrome (CRPS) is contradictory, with some studies suggesting high rates of symptom resolution, whilst others demonstrate that CRPS symptoms can persist and lead to significant disability. The aim of the present study was to carefully document the extent of recovery from each of the signs and symptoms of CRPS.

Does kindness matter? Self‐compassion buffers the negative impact of diabetes‐distress on HbA1c

Higher self‐compassion is associated with mental and physical health benefits in both healthy and chronically ill populations. The current study investigated the role of self‐compassion in predicting depression, diabetes‐specific distress and HbA1c in patients with diabetes.

Cognitive behavioral therapy for chronic pain: Strategies for the successful use of homework assignments

Presents an overview of the research findings to date, and practical guidelines for the use of homework in psychosocial treatments for patients with chronic pain. Generally, psychosocial treatments incorporating homework assignments help patients to improve more than when treatment is comprised entirely of in-session work. The article outlines common obstacles experienced when using homework with pain patients and strategies to combat these obstacles. The types of homework assignments that may be most helpful, as well as interventions that can be used to promote homework compliance and successful treatment outcome are discussed.

Why do older people oppose physician-assisted dying? A qualitative study

Background: Physician-assisted dying at the end of life has become a significant issue of public discussion. While legally available in a number of countries and jurisdictions, it remains controversial and illegal in New Zealand. Aim: The study aimed to explore the reasons some healthy older New Zealanders oppose physician-assisted dying in order to inform current debate. Design: Recorded interviews were transcribed and analysed by the authors after some edits had been made by respondents. Setting/participants: In all, 11 older participants (over 65 years) who responded to advertisements placed in Grey Power magazines and a University of Auckland email list were interviewed for around 1 h and asked a number of open-ended questions. Results: Four central themes opposing physician-assisted dying were identified from the interviews: one’s personal experience with health care and dying and death, religious reasoning and beliefs, slippery slope worries and concern about potential abuses if physician-assisted dying were legalised. Conclusions: An important finding of the study suggests that how some older individuals think about physician-assisted dying is strongly influenced by their past experiences of dying and death. While some participants had witnessed good, well-managed dying and death experiences which confirmed for them the view that physician-assisted dying was unnecessary, those who had witnessed poor dying and death experiences opposed physician-assisted dying on the grounds that such practices could come to be abused by others.

Factors Associated With Disability and Sick Leave in Early Complex Regional Pain Syndrome Type-1.

Objective:Factors influencing disability and work absence in complex regional pain syndrome type-1 (CRPS)-1 have not been thoroughly described in the literature. We sought to determine whether demographic variables, work-related factors, CRPS clinical severity ratings, pain scores, or psychological variables were associated with disability and sick leave in early CRPS-1. Methods:A total of 66 CRPS-1 patients were recruited within 12 weeks of CRPS onset. Patients completed measures of pain, depression, anxiety, stress, pain catastrophizing, and pain-related fear. A physical examination was conducted to assess signs and symptoms of CRPS and to calculate a CRPS severity score. Demographic details, clinical details, treatments, work type, and work status were recorded. Results:In multivariate analyses, the following factors were associated with greater disability: higher pain scores, more restricted ankle or wrist extension, and higher levels of depression. Among the 49 who were either working or studying before developing CRPS, 28 had stopped work or study at the time of assessment. Multivariate analyses showed that sick leave was more likely among those whose CRPS was triggered by more severe injuries, whose work was more physically demanding, among those with higher disability scores, and there was also a significant effect of depression on sick leave, which was mediated by disability. Discussion:Although the study was cross-sectional and so cannot differentiate cause from effect, results suggest that even in the early stages of CRPS, a cycle of pain, disability, depression, and work absence can emerge. Treatments aimed to prevent this cycle may help prevent adverse long-term outcomes.

Does Kindness Matter? Diabetes, Depression, and Self-Compassion: A Selective Review and Research Agenda

Depression and severe psychological distress are frequently comorbid with diabetes and are associated with reduced adherence to medication and healthy lifestyle regimens, poorer glycemic control, and increased complications. The mixed success of existing treatments for depression in diabetes patients suggests a need for supplementary approaches to this common problem. This article reviews recent evidence for the benefits of self-compassion in chronically ill patients, suggesting its utility as a clinical tool for improving self-care, depression, and glycemic control in diabetes. Possible physical and psychological pathways by which self-compassion may promote better outcomes in diabetes patients are considered, with particular attention given to reductions in negative self-judgment and improved motivation to undertake self-care.