Objective: Chronic pain is a common condition worldwide that poses significant impact to society in terms of its health and economic costs. It has been found to be related to a number of emotional and cognitive factors that are amenable to psychological treatments. Traditional cognitive-behavioral therapy (CBT) for chronic pain has become the gold standard of psychological treatment with reported efficacy. However, recent meta-analyses have found its effect size to be only modest at most. Moreover, its specific mechanisms of action are not well elucidated. With recent advances in neuroscience on possible neurocognitive processes underlying chronic pain, alternative treatment models targeting these specific neurocognitive processes are worth exploring. The present study tested the effectiveness of the Four-step Mindfulness-based Therapy (FSMT) for chronic pain in a randomized-controlled trial. The FSMT was chosen because of its explicit emphasis on altering neurocognitive processes that appear to be highly relevant in treating chronic pain. Method: Ninety-nine chronic pain patients in a hospital cluster-based outpatient pain clinic were randomly allocated to either the FSMT treatment or wait-list control group. The FSMT was modified for use with chronic pain and incorporated mindfulness exercises, such as mindful breathing and mindful meditation. Treatment consisted of eight weekly two-hour group sessions conducted by a clinical psychologist experienced in the implementation of the FSMT protocol. Assessment took place at baseline and post-treatment for both the FSMT and wait-list control. For the FSMT, assessment also took place at mid-group and 3-month follow-up. Results: Findings showed that the FSMT produced superior outcomes in terms of activity interference (primary endpoint), pain unpleasantness, and depression when compared to the wait-list control group or over time. Improvements were also found in the process measures of pain catastrophizing and pain acceptance. All treatment effects were maintained at follow-up. Further, the effects have been shown to be clinically significant and reliable above and beyond measurement errors. Mediational analyses revealed that pain catastrophizing and pain acceptance mediated the effects of FSMT on the outcomes of activity interference and depression; pain catastrophizing also mediated the effect of FSMT on the outcome of pain unpleasantness. Conclusions: The present study was the first to establish statistical and clinical evidence of the FSMT for chronic pain. It also revealed possible processes and mechanisms that might have brought about the changes in outcome, namely reduction in pain catastrophizing and improvement in pain acceptance. How the FSMT led to the outcome changes via these two processes was discussed and enriched by neurocognitive perspectives. Future studies should seek to further compare the FSMT with other active psychological treatments for chronic pain and collect neuroimaging data to further illustrate the neurocognitive processes involved. / Wong, Chi Ming. / "October 2009." / Adviser: Freedom Leung. / Source: Dissertation Abstracts International, Volume: 72-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 139-175). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

The present study evaluated the utility of heart rhythm coherence (HRC) feedback to reduce the reported pain intensity of patients enrolled in a multimodal pain management program. Participants were recruited and assigned to a usual treatment group (UT) or a heart rhythm coherence feedback group (UT+HRC). It was hypothesized that UT+HRC participants who achieved heart rhythm coherence would report a reduction of pain intensity, as measured by the McGill Pain Inventory. For those whose pain intensity decreased, it was also expected that their self reported levels of depression as measured by the Beck Depression Inventory-Second Edition and state anger as measured by the State Trait Anger Inventory would decrease. It is also hypothesized that with a reduction in pain levels, anger, and depression, blood pressure would also decrease among those who had high blood pressure prior to the intervention. Multivariate analyses of variance (MANOVA) were used to investigate the relationship between treatment condition, coherence status and pain levels. A series of independent t-tests were utilized to investigate the change in pain, depression, and state anger from baseline to posttest, followed by Pearson product moment correlation coefficients on difference scores to understand the relationship between the outcome variables for Hypothesis 2. Standard multiple regression analyses were computed using difference scores to determine if the outcome measures were significant predictors of systolic blood pressure and diastolic blood pressure. Results indicated a failure to reject the null with regard to hypothesis one. No relationship between treatment assignment, coherence status or pain levels were found. Hypothesis 2 was partially supported. Although there was a positive significant relationship between depression and anger when utilizing difference scores, these affective measures were not related to difference scores on either pain measure. In regard to Hypothesis 3, there was also a failure to reject the null. None of the outcome measures utilized in this study emerged as being significantly related to changes in systolic or diastolic blood pressure. Limitations of the study and implications for future research are offered.

In this study, the use of hypnosis in the treatment of chronic low back pain is described in terms of Ecosystemic thinking, as opposed to traditional conceptualisations of hypnosis. Six case studies were used. Each is described in detail, as well as the therapeutic rationale behind each case, in order to present the reader with an understanding of the thinking behind using Ecosystemic hypnotherapy. / Psychology / M.A. (Psychology)

The present study investigated the influence of a brief, intensive biofeedback-assisted imagery training regimen on psychological, physiological and neuroendocrinological measures of pain and stress in injury related chronic pain patients. The subjects were 36 patients (myelography examcandidates) who were assigned to the imagery or wait-list control group by order of referral presentation and to formulate equivalent groups.

The undertreatment of chronic pain and the prevention of drug abuse and diversion of pain medications (i.e., opioids) have been identified as public health issues in the United States. In this domain, the Drug Enforcement Administration (D.E.A.) faces challenges when enforcing the Controlled Substance Act because it is tasked with regulating the dispensing of opioids by physicians in the treatment of chronic pain, while also attempting to prevent their abuse and diversion. Thus, the D.E.A. must use discretion in how it enforces the C.S.A. because intentional actions to prevent opioid abuse and diversion could also unintentionally affect the willingness of primary care physicians to prescribe them in the treatment of chronic pain. As an initial step in clarifying the boundaries between the D.E.A. and the medical profession, it was necessary to assess physician perceptions about the D.E.A. 's use of enforcement discretion. A total of 205 Oregon primary care physicians completed a web-based survey examining three domains: concern about D.E.A. enforcement discretion; autonomy related to use of opioids in the treatment of chronic pain; and prescribing of opioids in the treatment of chronic pain. Results indicated that some physicians perceive a concern about D.E.A. enforcement discretion, and those who have concern are more likely to perceive having reduced autonomy related to the use of opioids in the treatment of chronic pain. The results do not support previous research that showed that such concerns directly affects physician prescribing of opioids. Instead, results reveal that concern about D.E.A. enforcement discretion is associated with reduced perceived autonomy, and reduced perceived autonomy is associated with less willingness to prescribe opioids in the treatment of chronic pain. This research takes the study on this topic one step further in identifying physician perceptions about D.E.A. enforcement discretion, and how these perceptions were associated with physician autonomy and prescribing of opioids in the treatment of chronic pain. In doing so, this research provides important scholarly contributions to the enforcement discretion literature, specific to the D.E.A., and medical professionalism as it pertains to physician autonomy related to the use of opioids in the treatment of chronic pain.

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In this study, the use of hypnosis in the treatment of chronic low back pain is described in terms of Ecosystemic thinking, as opposed to traditional conceptualisations of hypnosis. Six case studies were used. Each is described in detail, as well as the therapeutic rationale behind each case, in order to present the reader with an understanding of the thinking behind using Ecosystemic hypnotherapy. / Psychology / M.A. (Psychology)

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background: Myofascial Pain and Dysfunction (MPD) is a diagnosis commonly encountered by practitioners, hence, there are several treatment approaches employed by various practicing physicians. Practitioners are required to perform evidence-based protocols on patients; however, such intervention becomes increasingly difficult with the increasing volume of evidence available with regards to treatment of MPD. A systematic review provides a well-structured, critical analysis of the available protocols, and as such, provides practitioners with an evidence-based summary of the available modalities and the effectiveness of these modalities. Thus, the aim of the study was to systematically review and evaluate the literature to determine the effects of various non-invasive modalities on MPD. Objectives: Studies investigating various non-invasive modalities were identified, evaluated against the inclusion criteria and then reviewed against PEDro criteria to present current available evidence regarding their effectiveness as a source of treatment for MPD. Methods: A literature search was conducted, based on key terms including: active and latent myofascial trigger points, manual therapy, manipulation, acupressure, massage, muscle stretching, ultrasound, transcutaneous electric nerve stimulation, electric stimulation therapy, magnetic field therapy, and exercise therapy. Databases searched were: PubMed, EBSCOhost, Medline, CINAL, Proquest, Health Source, Sport Discus, Science Direct, Springer Link, Google Scholar and Summons. The articles were screened according to inclusion and exclusion criteria, after which a secondary hand and reference searches were performed. Thereafter, the articles were reviewed by four independent reviewers and the researcher. The PEDro Scale was used to determine methodological rigor of the included studies. The results were then analysed and ranked. Results: Following the screening process during data collection for this study, a total of 25 studies were identified and included. The review and ranking of these studies revealed a moderate level of evidence present for the effectiveness of Topical Agents. A limited level of evidence was noted for TENS, Ischemic Compression, Ultrasound, Laser and Other Modalities. Approximately 25% of the reviewed studies involved combination therapies; hence their outcomes cannot be applied to the effectiveness of individual modalities. Conclusion: Upon comparison of the quality of evidence available for the various types of modalities present for the treatment of MPD, it was noted that Topical Agents were supported by a stronger level of evidence than TENS, Ischeamic Compression, Ultrasound, Laser and Other Modalities. However, due to a lack of strong overall evidence for any of these modalities it has been concluded that more research is required to establish which modality is in fact the most effective.

Indiana University-Purdue University Indianapolis (IUPUI) / The presence of a chronic pain condition can have a profound impact on one’s self-concept. Some individuals may have had to make major lifestyle changes. As a result, some people may start to define themselves in terms of their pain, such that their self-schema and pain-schemas become intertwined in a process termed schema-enmeshment. It is thought that schema-enmeshment is related to psychological distress making it a prime target for intervention. Little research has been conducted on interventions to reduce schema-enmeshment. Acceptance-based interventions may be especially appropriate in reducing schema-enmeshment or the connection between self and illness symptoms as these interventions tend to emphasize learning to live with pain and other symptoms and to work toward important life goals rather than continually fighting against the condition and allowing it to control their life. This study is a randomized trial comparing Acceptance and Commitment Therapy (ACT) to education about pain management in a sample of women with Fibromyalgia Syndrome (FMS). The primary aim of this study was to assess the efficacy of ACT in reducing schema-enmeshment between self and pain, as well as enmeshment between self and other symptoms and FMS as a whole. In addition, this study also explored the role of pain acceptance, specifically activity engagement as a mediator of the relationship between treatment group membership and changes in schema-enmeshment. The data was analyzed as an intent-to-treat analysis using the “last measure carried forward” method. Results indicated that the ACT group reported statistically significant differences in self schema-enmeshment with FMS, fatigue, and cognitive symptoms, but not with pain, following the intervention, compared to the educational control group. In each of these cases, the ACT group experienced greater reductions in schema-enmeshment compared to the education group. Interestingly, no statistically significant differences were observed for schema-enmeshment with pain. Statistically significant group differences were also observed for acceptance of pain following the intervention. Finally, a mediational model in which changes in activity engagement (a form of pain acceptance) served as the mediator of the relationship between treatment group and changes in schema-enmeshment with FMS was tested. The model was tested using a bootstrapping method, and results revealed a trend toward a significant indirect effect of changes in activity engagement leading to changes in schema-enmeshment with FMS. Taken together, the results of this study indicate that ACT may be a promising intervention for targeting maladaptive beliefs about the self in relation to illness, especially schema-enmeshment of self with illness and illness symptoms. Additionally, there is evidence that ACT may target key constructs such as activity engagement, which may be related to other cognitive and behavioral changes. Future directions for research and clinical practice related to ACT as an intervention for FMS are discussed in depth.