No description available.

Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.

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.

Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.