Meta-analysis of psychological interventions for chronic low back pain.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.     

Psychiatric pain and deliberate suffering

In public opinion and in medical practice the suffering of psychiatric patients is often considered self‐induced. Freudian psychoanalysis embraced this notion but managed to reconcile it with the pleasure principle only by positing an instinctual craving for death, to which Freud reduced instances of deliberate and repetitive suffering. In a simultaneous but separate line of thought, he also reduced all habits, including self‐destructive ones, to masturbation and all inhibitions of constructive drives to inhibitions of masturbation. This article explores this seeming paradox.

The transition from a paranoid‐schizoid position to a depressive one begins with the dawning assumption of ownership of certain aspects of one's being, with the correlative attribution of other aspects to the world outside the self. Inevitable errors in this process create tensions that may be discharged by suffering, either by atonement or by assuming ownership of the pain that one's dependency might otherwise inflict on one's objects. Eros serves Thanatos to preserve self‐ownership. Pragmatically, owning one's fate can feel more important than enjoying it, a fact the author dubs the “Principle of Ownership”; and illustrates with a number of literary and clinical vignettes.

The idea that psychiatric suffering is self‐induced contributes to the stigma that so commonly attends it. Ironically, this same idea makes psychological treatment possible: if painful adjustments replace relationships, then new relationships may have the power to correct them.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Time perspective,socioeconomic status,and psychological distress in chronic pain patients

Time perspective (TP) is a fundamental dimension of the psychological construction of time. It refers to a subjective experience and can be defined as the relationship that individuals and groups have with the present, past, and future. Studies have shown that it is interesting to take into account TP in the field of health, especially for the study of the psychological distress (PD) of individuals faced with aversive situations. We conducted a research, which aimed to explore the relationship between TP and PD in patients with chronic pain. A total of 264 first-time patients (72.3% women; mean age = 49 years) at CHU Timone (Marseille) pain center answered a questionnaire included TP, socioeconomic status, pain beliefs (PB), pain characteristics, and sociodemographic characteristics. Using hierarchical regression analyses adjusted to the characteristics of pain, sociodemographic characteristics, and PB, we can observe significant relationships between different components of TP, socioeconomic status, and PD. These results emphasize the importance of TP as psychosocial variable in the analysis of PD in patients with chronic pain. These results also lead us to point out the role of the socioeconomic status that predicts levels of PD.     

Linguistic and other psychological aspects of paroxysmal aphasia

A case of paroxysmal aphasia is reported. Aphasic spells occurred, in this patient, without modification in consciousness and without involvement of behaviors others than those related to oral and written speech and language. Longer spells successively recapitulated the clinical pictures of global, Wernicke's, conduction, and amnestic aphasia. Besides aphasiological evaluations, neurological, psychometrical, electroencephalographical, and CT-scan documents were obtained. The discussion bears on four main points: the linguistic characteristics of paroxysmal aphasia as compared to those of aphasias of other etiologies; Pierre Marie's oneness doctrine of aphasia; the mutual relationships of language and thought (in aphasia); the affective experience lived by one with severe aphasia, with special reference to the notion of anosognosia.     

Neurocognitive aspects of pain perception

The perception of pain is sensitive to various mental processes such as the feelings and beliefs that someone has about pain. It is therefore not exclusively driven by the noxious input. Attentional modulation involving the descending pain modulatory system has been examined extensively in neuroimaging studies. However, the investigation of neural mechanisms underlying more complex cognitive modulation is an emerging field in pain research. Recent findings indicate an engagement of the ventrolateral prefrontal cortex during more complex modulation, leading to a change or reappraisal of the emotional significance of pain. Taking placebo-induced analgesia as an example, we discuss the contribution of attention, expectation and reappraisal as three basic mechanisms that are important for the cognitive modulation of pain.     

Meta-analyses and systematic reviews of psychological treatments for chronic pain: relevance to an evidence-based practice.

As evidence-based practitioners become more reliant on systematic reviews to inform treatment, it becomes important to systematize reporting details as well as improve the quality of the primary studies that will later be incorporated into this secondary literature. In this article, the authors consider several specific factors that can serve this function in the area of chronic pain: (a) adhering to a standardized set of reporting standards; (b) measuring a standardized set of short- and long-term outcome variables; (c) providing information about individual differences; and (d) providing detailed, easily accessible documentation of the treatment program (or progams). The article also highlights ways that practitioners and researchers can collaborate on treatment outcome research, thereby improving the ability to discover and disseminate effective treatments for patients who suffer from chronic pain.