Attitudes towards complementary and alternative medicine in chronic pain syndromes: a questionnaire-based comparison between primary headache and low back pain

<p>Abstract</p> <p>Background</p> <p>Complementary and Alternative Medicine (CAM) is widely used and popular among patients with primary headache or low back pain (LBP). Aim of the study was to analyze attitudes of headache and LBP patients towards the use of CAM.</p> <p>Methods</p> <p>Two questionnaire-based surveys were applied comparing 432 primary headache and 194 LBP patients.</p> <p>Results</p> <p>In total, 84.75% of all patients reported use of CAM; with significantly more LBP patients. The most frequently-used CAM therapies in headache were acupuncture (71.4%), massages (56.4%), and thermotherapy (29.2%), in LBP thermotherapy (77.4%), massages (62.7%), and acupuncture (51.4%). The most frequent attitudes towards CAM use in headache vs. LBP: "leave nothing undone" (62.5% vs. 52.1%; p = 0.006), "take action against the disease" (56.8% vs. 43.2%; p = 0.006). Nearly all patients with previous experience with CAM currently use CAM in both conditions (93.6% in headache; 100% in LBP). However, the majority of the patients had no previous experience.</p> <p>Conclusion</p> <p>Understanding motivations for CAM treatment is important, because attitudes derive from wishes for non-pharmacological treatment, to be more involved in treatment and avoid side effects. Despite higher age and more permanent pain in LBP, both groups show high use of CAM with only little specific difference in preferred methods and attitudes towards CAM use. This may reflect deficits and unfulfilled goals in conventional treatment. Maybe CAM can decrease the gap between patients' expectations about pain therapy and treatment reality, considering that both conditions are often chronic diseases, causing high burdens for daily life.</p

The cross-sectional GRAS sample: A comprehensive phenotypical data collection of schizophrenic patients

<p>Abstract</p> <p>Background</p> <p>Schizophrenia is the collective term for an exclusively clinically diagnosed, heterogeneous group of mental disorders with still obscure biological roots. Based on the assumption that valuable information about relevant genetic and environmental disease mechanisms can be obtained by association studies on patient cohorts of ≥ 1000 patients, if performed on detailed clinical datasets and quantifiable biological readouts, we generated a new schizophrenia data base, the GRAS (Göttingen Research Association for Schizophrenia) data collection. GRAS is the necessary ground to study genetic causes of the schizophrenic phenotype in a 'phenotype-based genetic association study' (PGAS). This approach is different from and complementary to the genome-wide association studies (GWAS) on schizophrenia.</p> <p>Methods</p> <p>For this purpose, 1085 patients were recruited between 2005 and 2010 by an invariable team of traveling investigators in a cross-sectional field study that comprised 23 German psychiatric hospitals. Additionally, chart records and discharge letters of all patients were collected.</p> <p>Results</p> <p>The corresponding dataset extracted and presented in form of an overview here, comprises biographic information, disease history, medication including side effects, and results of comprehensive cross-sectional psychopathological, neuropsychological, and neurological examinations. With >3000 data points per schizophrenic subject, this data base of living patients, who are also accessible for follow-up studies, provides a wide-ranging and standardized phenotype characterization of as yet unprecedented detail.</p> <p>Conclusions</p> <p>The GRAS data base will serve as prerequisite for PGAS, a novel approach to better understanding 'the schizophrenias' through exploring the contribution of genetic variation to the schizophrenic phenotypes.</p

Die deutsche Fassung der Schmerzkatastrophisierungsskala (SKS-D) - psychometrische Analyse und Evaluation des Konstrukts

Objective: The Pain Catastrophizing Scale, adapted for children (PCS-C) by Crombez et al. (2003), was translated into German (SKS-D) and evaluated regarding its factorial structure, its reliability and validity. The association of catastrophizing with various pain characteristics and disability measures was examined as well as its association to neighboring constructs.Method: The paper-and-pencil version of the SKS-D was used in two different samples of children and adolescents. Analyses were conducted on a subgroup of participants from an epidemiological sample [n=898; age: M=12.9 (SD=1.4)] who had experienced monthly headaches in the 6-months period before and a clinical sample [n=60; age: M=12.6 (SD=0.8)] seeking treatment for recurrent headaches.Results: Exploratory factor analysis (PCA) suggested a one-factor model in contrast to the 3-factor model suggested by Crombez et al. (2003). The unidimensional scale showed distinct homogeneity and satisfying reliability. The clinical sample showed significantly higher scores than the epidemiological group. Also girls scored higher than boys. The catastrophizing explained a considerable amount of variance in pain and disability parameters in both samples thus underlining its validity.The psychological variables internalising, anxiety sensitivity and somatosensory amplification showed significant small to moderate associations with pain catastrophizing and also with pain and disability. After controlling for the above mentioned psychological variables, catastrophizing still yielded an independent contribution to the explanation of variance in pain and disability parameters.Conclusions: The PCS-C in its German form is a valid and reliable instrument for assessing catastrophizing in children with recurrent pain, in particular headache, in the age of 10-16 years. Pain catastrophizing is suggested to be assessed especially in pediatric pain patients as it is a significant moderator of pain and disability. In children with a distinct tendency to catastrophize cognitive restructuring should become a target of pediatric pain therapy, as a reduction of catastrophizing cognitions may indirectly help to ameliorate pain and disability.Ziel: Die "Pain Catastrophizing Scale" für Kinder (PCS-C) von Crombez et al. (2003) wurde ins Deutsche übersetzt (SKS-D) und hinsichtlich ihrer faktoriellen Struktur, ihrer Reliabilität und Validität evaluiert. Der Zusammenhang von Katastrophisierung mit verschiedenen Schmerzparametern und Beeinträchtigungskennwerten sowie benachbarten Konstrukten wurde analysiert.Methode: Die Papier-und-Bleistift Version des SKS-D wurde zwei verschiedenen Stichproben von Kindern und Jugendlichen vorgelegt, einer Subgruppe eines bevölkerungsbasierten, epidemiologischen Samples (N=898, Alter: M=12,9 (SD=1,4)), die angab, an wiederkehrenden Kopfschmerzen in den 6 Monaten vor der Erhebung gelitten zu haben und einer klinischen Stichprobe (N=60, Alter: M=12,6 (SD=0,8)), die sich wegen wiederkehrenden Kopfschmerzen um psychologische Behandlung bemüht hatte.Ergebnisse: Eine exploratorische Faktorenanalyse (PCA) ergab ein ein-faktorielles Modell im Gegensatz zu einem drei-faktoriellen Modell, das Crombez et al. (2003) vorgeschlagen hatten. Die eindimensionale Skala zeigt eine sehr hohe Homogenität und zufriedenstellende Reliabilität. Die klinische Stichprobe zeigte signifikant höhere Werte in der Katastrophisierung als die nicht-klinische Gruppe. Mädchen wiesen höhere Werte auf als Jungen. Die SKS-D erklärt in den Schmerz-und Beeinträchtigungsparametern einen bedeutsamen Anteil der Varianz und zwar in beiden Stichproben, was die Validität stützt.Die ausgewählten psychologischen Variablen nämlich Internalisierung, Angstsensitivität und somatosensorischen Amplifikation, zeigten signifikante kleine bis moderate Korrelationen mit der Schmerzkatastrophisierung sowie mit Schmerz- und Beeinträchtigungskennwerten. Bei Kontrolle der psychologischen Variablen zeigte die Katastrophisierung weiterhin signifikante Korrelationen mit Schmerz- und Beeinträchtigungsparametern,was wiederum als Hinweis für die Validität des Fragebogens gewertet werden kann.Schlussfolgerungen: Die SKS-D ist ein reliables und valides Instrument zur Erfassung katastrophisierender Tendenzen bei Schmerz in der Gruppe von Kindern und Jugendlichen mit wiederkehrenden Schmerzen, insbesondere Kopfschmerz, in der Altersgruppe von 10-16 Jahren. Schmerzkatastrophisierung sollte insbesondere bei pädiatrischen Patienten erfasst werden, da es ein bedeutsamer Moderator von Schmerzerleben und Beeinträchtigungsempfinden ist. Bei Patienten mit starken Katastrophisierungstendenzen sollte kognitive Umstrukturierung ein zentraler Bestandteil der Schmerztherapie sein, da eine Reduktion dieser Tendenzen auf indirektem Wege zu einer Schmerz- und Beeinträchtigungsminderung führen kann

Nocebo hyperalgesia: contributions of social observation and body-related cognitive styles

Elisabeth V&ouml;gtle,1 Birgit Kr&ouml;ner-Herwig,1 Antonia Barke21Department of Clinical Psychology and Psychotherapy, Georg-Elias-M&uuml;ller-Institute for Psychology, University of G&ouml;ttingen, G&ouml;ttingen, 2Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany Purpose: Recently, it has been shown that nocebo hyperalgesia can be acquired through observational learning. The aim of this study was to investigate socially induced nocebo hyperalgesia and its relationship with pain catastrophizing, somatic complaints, hypochondriacal concerns, and empathy. Participants and methods: Ninety-seven women (43.1&plusmn;15.5 years) were randomly assigned to one of the two conditions. Participants in the nocebo condition (NC) watched a video in which a female model displayed more pain when an ointment was applied and less pain when no ointment was applied. In the control condition (CC), the model demonstrated low pain with and without the ointment. Subsequently, all participants received three pressure pain stimuli (60 seconds) on each hand. On one hand, the ointment was applied prior to the stimulation. The order of the stimulation of the fingers (middle, index, or ring finger), the side of ointment application (left or right hand), and the side with which the stimulation began were randomized within each group and balanced across the groups. Depending on the randomization, the pressure pain application started with or without ointment and on the left or right hand. Pain ratings on a numerical rating scale (0&ndash;10) were collected. In addition, the participants completed questionnaires regarding body-related cognitive styles and empathy. Results: There was a significant difference in the pain ratings between the CC and the NC. The effect of ointment application was also significant, but no interaction between condition and ointment application was found. Only in the CC did the nocebo response correlate with hypochondriacal concerns and somatic complaints. Conclusion: Application of an ointment as well as the observation of a model demonstrating more pain after a treatment produced elevated pain ratings. Cognitive styles were not related to the socially induced nocebo response, but were related to the nocebo response in the CC. Keywords: nocebo response, pain, social observation, pain catastrophizing, hypochondriasi

Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence

Birgit Kr&ouml;ner-Herwig,&nbsp;Anastasia Gorbunova,&nbsp;Jennifer Maas Department of Clinical Psychology and Psychotherapy, Georg-Elias-M&uuml;ller-Institute of Psychology, University of G&ouml;ttingen, G&ouml;ttingen, Germany Abstract: The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18&ndash;27&nbsp;years) from data assessed in childhood or adolescence, i.e., 9&nbsp;years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of &gt;5000 families with children aged between 7 and 14&nbsp;years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected. Keywords: headache, back pain, prediction of adult pain, risk factors, biopsychological interactio

Beeinflussen Patientenmerkmale den Erfolg einer ambulanten Behandlung des chronischen Tinnitus?

Various patient characteristics were assessed before offering a treatment to reduce tinnitus related distress to 57 individuals suffering from chronic idiopathic tinnitus. Patients were randomly assigned to a cognitive-behavioral tinnitus coping training (TCT) and a habituation-based training (HT) modelled after Tinnitus Retraining Therapy (TRT) as conceived by Jastreboff. Both trainings were conducted in groups. It was hypothesized that comorbidity regarding mental disorders or psychopathological symptoms (DSM-IV diagnoses, SCL-90R score) and a high level of dysfunctional cognitions relating to tinnitus would have a negative effect on therapy outcome while both trainings proved to be highly efficacious for the average patient. Also further patient features (assessed at baseline) were explored as potential predictors of outcome. None of the hypotheses was corroborated by the data. On the contrary, a higher number of diagnoses was associated with better outcome (statistical trend) and a higher extent of annoyance and interference led to a larger positive change in patients if treated by TCT. No predictor could be identified for long-term success (follow-up >=18 months) except regarding education. The higher the educational level, the larger was the improvement in HT patients. It is concluded that therapy outcome of TCT and HT can not reliably be predicted by patient characteristics and that early variables of the therapeutic process should be analysed as potentially predicting subsequent therapeutic outcome.Es ist bisher noch nicht untersucht worden, ob der Erfolg einer ambulanten Behandlung von idiopathischem Tinnitus durch das Vorliegen einer psychopathologischen Belastung beeinträchtigt wird oder andere Tinnitus-relevante Patientenvariablen die Wirksamkeit moderieren.In einem randomisierten Kontrollgruppendesign wurde die Wirksamkeit eines kognitiv-behavioralen Tinnitusbewältigungs-Trainings (TBT) und eines habituationsbasierten Trainings (HT), angelehnt an die Konzeption der Tinnitus Retraining Therapie nach Jastreboff, verglichen (N=57). Als Outcomekriterium fungierte der Beeinträchtigungsscore aus dem Tinnitusfragebogen von Goebel u. Hiller . Mittels des MiniDIPS-Interviews wurden wesentliche psychopathologische Diagnosen abgeklärt. Aus der SCL-90R wurde der Globale Belastungsscore (GSI) als eine weitere unabhängige Variable genutzt. Ein Fragebogen zu dysfunktionalen Kognitionen zu Tinnitus lieferte die dritte Prädiktorvariable, zu der die Hypothese eines negativen Zusammenhangs zum Therapieerfolg formuliert wurde. Als potentielle Prädiktorvariablen wurden zusätzlich Dauer und Lautstärke des Tinnitus sowie andere Tinnitus-relevante Parameter ausgewählt. Die Hypothesen konnten nicht bestätigt werden. Es ergaben sich keine signifikanten Korrelationen weder in der Gesamtgruppe noch innerhalb der einzelnen Trainingsgruppen. Tendenziell zeigten sich bei der TBT Gruppe einige positive Zusammenhänge zwischen Ausgangsbelastung und Ausmaß des Erfolgs. Der Erfolg des HT (im follow-up) hing mit der Schulbildung der Patienten zusammen. Beide Verfahren, die bezogen auf die Reduzierung der Tinnitusbelastung nahezu gleich wirksam sind, zeigen keine differentielle Effektivität in Abhängigkeit von der Psychopathologie des Patienten. Diese stellt also keine Kontraindikation für ambulante Therapien der verwendeten Art dar. Einige Daten sprechen dafür, dass bei mit TBT behandelten Patienten eine höhere psychopathologische Ausgangsbelastung und ein höheres Level an Tinnitus-bezogener Beeinträchtigung sogar eine größere Verbesserung erwarten lässt