A different thing altogether: an idiographic case study of breast cancer in men using interpretative phenomenological analysis

Background: Around 300 men are diagnosed annually with breast cancer in the UK. In comparison to the wealth of information on breast cancer for women there is paucity of information in the literature regarding the psychological consequences of being a man with breast cancer. Male breast cancer constitutes a unique lived experience for men due to its strong identity as a gender-specific disease. Methods: A case study was undertaken with a 55 year old man in the early recovery phase of breast cancer. An in-depth semi-structured interview was conducted using an interpretative phenomenological analysis (IPA, Smith 1996) approach to gain an insight into the participant’s lived experience of breast cancer.Results: Four superordinate themes emerged from the data: the Impact of the Cancer; Factors that influenced coping; Changing Identity: retaining masculinity despite limitations; and Feeling fortunate and a need for awareness.Conclusion: Acquiring further information on breast cancer in men allows services to be better positioned to help the recovery process by: offering suitable information, being aware of male psychological distress, increasing patient autonomy, normalising the experience to reduce exclusion, and promoting support outlets

The effects of psychological factors on efficacy of Spinal Cord Stimulation

Spinal cord stimulation (SCS) appears to be an effective treatment for neuropathic pains, but long-term benefit of more than one year is only found in a proportion of patients treated. This thesis hypothesised that psychological factors may be important as determinants of outcome. A literature review in this field, whilst demonstrating lack of reliable psychological predictors of SCS treatment, suggested that those thought to be predictive such as depression were more complex. Whilst depression was associated with lower efficacy of treatment by SCS, the treatment itself improved depression. Therefore, depression should not necessarily be seen as a contra indicator, especially when pain and depression interact. A prospective study with one year follow up of patients implanted with spinal cord stimulator was conducted. Forty patients were included in the final analysis. Functional pain and psychological measures were recorded at six and 12 months, psychological predictors were not significant at six months but significant predictors were found at 12 months. Greater catastrophising, paired with greater anxiety and less perceived control were associated with a < 30 % reduction in pain. A qualitative study of the experience of SCS using semi-structured interviews one year following SCS implantation revealed similar findings. Thirteen patients reported coping, lack of control and helplessness as impacting upon pain experience. A demand for clearer information systems was discussed in relation to SCS preparation. Information is needed to reduce unexpected experiences including potentially painful trial and body image concerns related to the implantable SCS device. Implications for practice included preparation with expert patients and a tailored preparatory CBT course. The findings from the two studies demonstrate the necessity to improve the preparation process for patients prior to SCS. Results from both studies conclude that perception of control over pain is important for SCS efficacy and support with anxiety and catastrophic thoughts and behaviours may be advantageous. The predictive equation generated from this study needs to be tested prospectively on further cohorts of SCS patients in order to test reliability. In addition, evaluation of the impact of a tailored CBT course upon outcome needs investigation

Attrition with spinal cord stimulation

The aim of this prospective study was to investigate whether spinal cord stimulation (SCS) significantly reduces pain intensity for up to 18-month follow-up in patients with chronic neuropathic pain. Forty-eight patients were recruited. Patients rated their pain using a Visual analog scale (VAS) and pain-related disability using the Oswestry Disability Index (ODI) at baseline (1 week prior to SCS surgery) and at 6-, 12-, and 18-month follow-up. Pain intensity significantly decreased from baseline to all 3 time points [F (3,135) = 16.264, p < 0.001]. The greatest difference in the reduction of pain intensity was observed between baseline (M = 7.20, SD = 1.34) and 6-month follow-up (M = 4.60, SD = 2.20), [t(47) = 6.741, p < 0.001]. However, when looking at differences between the 6-month follow-up and subsequent assessments, statistically significant increases in pain intensity from the 6-month to the 12-month follow-up [t(47) = -2.788, p = 0.008], and from the 6-month to the 18-month follow-up [t(47) = -3.339, p = 0.002] could be observed. Statistically significant changes were also observed for clinical changes in pain scores [F (2,94) = 4.972, p = 0.009. There was a significant decrease in the percentage of clinical change obtained from the 6-month (M = 33.19, SD = 35.63) to the 12-month follow-up (M = 23.76, SD = 33.62), [t(47) = 2.347, p = 0.025], and from the 6-month to the 18-month follow-up (M = 18.34, SD = 33.51), [t(47) = 3.072, p = 0.004]. A number of patients also reported higher levels of pain intensity at the 12-and 18-month follow-up than at baseline.Pain-related disability scores significantly decreased from baseline (M = 55.04, SD = 16.43) to the 6-month follow up (M = 46.98, SD = 19.05), [t(47) = 3.464, p = 0.001] and from baseline to the 12-month follow up (M = 48.49, SD = 20.94), [t(47) = 2.918, p = 0.005], but not during the 18-month follow up (M = 51.75, SD = 20.92), [t(47) = 1.330, p =.190]. There was a significant increase in pain-related disability between the 6- and the 18-month follow up [t(47) = -2.188. p = 0.034]. These findings suggest that the beneficial effect of SCS on pain intensity may diminish over time, and that the 6-month follow-up scores may reflect a placebo effect. © 2015 The Neurosurgical Foundation

Analysis of psychological characteristics impacting spinal cord stimulation treatment outcomes:a prospective assessment

Background: Psychological factors are recognised as influencing the outcome of spinal cord stimulation (SCS) although there is currently no consensus as to which factors impact upon SCS efficacy. Objective: To identify psychological characteristics that may impact the efficacy of SCS. Study Design: Prospective evaluation. Setting: Single secondary care center in Dudley, United Kingdom. Methods: Patients: Seventy-five patients were initially recruited and 56 patients (31 women and 25 men) were followed-up for 12-months. Intervention: SCS for the management of chronic non-cancer pain. Main Outcome Measures: Outcome measures assessed at baseline, 6 months, and 12 months following SCS implantation included the visual analogue scale (VAS), Oswestry disability index (ODI), hospital anxiety and depression (HAD) scale, and the pain coping strategies questionnaire (PCSQ). Results: Statistically significant improvements were observed for the VAS (P < 0.001), ODI (P = 0.011), anxiety (P = 0.042), and depression (P = 0.010) in the HAD scale and for the subscales reinterpreting pain sensation (P = 0.018), control over pain (P = 0.001), and ability to decrease pain (P < 0.001) of the PCSQ. We observed that depression and autonomous coping (control over pain, ability to reduce pain, and catastrophizing) may impact sensory aspects such as pain intensity and disability scores affecting the outcome of SCS treatment. Age at time of implant and duration of pain prior to implant were also found to impact SCS efficacy. Limitations: It has been reported that loss of analgesia may be experienced within 12 to 24 months following SCS implantation and therefore, it would be of interest to follow patients over a longer period. Conclusions: This study demonstrates that psychological aspects such as depression and autonomous coping may impact SCS treatment. Addressing these issues prior to SCS implantation may improve SCS long-term outcome. © 2015, American Society of Interventional Pain Physicians. All Rights Reserved

Bodies as bearers of value: the transmission of jock culture via the ‘Twelve Commandments’

This article explores a number of insights generated from a three-year ethnographic study of one university setting in England in which a ‘jock culture’ is seen to dominate a student campus. Drawing on core concepts from Pierre Bourdieu's sociology of culture, it illustrates the unique function of the body in sustaining jock culture through the hierarchical ordering of bodies in institutional space. First, the development of this culture over time and the key dispositions that come to embody it are outlined. Next, the authors identify and illustrate the enactment of what they call the ‘Twelve Commandments’. These operate as a series of structured and structuring practices to condition the bodies of group members by appropriating an idealized and internalized jock habitus that is not gender neutral. Rather, it can be seen as a practical and symbolic manifestation of a dominant, heterosexual, masculine orientation to the world. The authors suggest that in spite of seemingly significant processes of accommodation over the years, the ‘illusio’ of this jock culture remains substantially intact and maintained through a combination of the following: (a) symbolic violence and (b) a systematic embodied complicity on the part of many of the actors who have something to gain by avoiding active subordination to, and exclusion from, the dominant group