Psychological Pain Management Research Articles

Quality of life in people with sickle cell disease treated with automated red blood cell exchange.

This review aims to explore the impact of sickle cell disease (SCD) on patients' quality of life (QoL) and the effectiveness of different transfusion modalities, particularly automated red blood cell exchange (aRBCX), in managing the factors that impact QoL. A systematic search was performed in PubMed to retrieve articles with data on QoL in SCD patients treated with aRBCX during the last 20 years. A targeted search for medical guidelines and a free search were added. When assessing the impact of the transfusion modality on the QoL of patients with SCD, some studies indicated an improvement in health-related QoL when using aRBCX while others reported no differences. The benefits of aRBCX include a decrease in length of hospital stay, pain-related hospitalizations and procedure time. The drawbacks of aRBCX were also identified, including an increased number of procedure-related complications (despite the overall number of complications showing no significant differences) and a more complex vascular access. Chronic red blood cell exchange favours psychosocial factors such as anxiety and social functioning, but the impact of using aRBCX in these parameters is not determined yet. aRBCX, known to be an efficient procedure to manage SCD, appears to be promising in improving patients' QoL. However, more comprehensive studies incorporating patient-reported outcomes are needed to fully understand the impact of different transfusion modalities on QoL in SCD patients. An integrated care approach, including psychological support and pain management, may further enhance QoL.

The association between physical intervention use and treatment outcomes in patients participating in an online and psychologically informed pain management program.

The availability of multidisciplinary care for the management of chronic pain is uncommon outside specialist clinics. The present study aims to determine the physical intervention use of patients participating in an online psychological pain management program and whether exposure to physical interventions in these patients alters treatment outcomes compared with patients who do not access physical interventions. Data were obtained from 2 previously published randomized controlled trials of an online psychological pain management program. Physical intervention exposure (categories: none, 1-3 sessions, 4+ sessions) was assessed at baseline, after treatment, and at 3-month follow-up. Primary outcomes included depression, anxiety, pain intensity, and pain-related disability. Generalized estimating equation models were used to compare treatment outcomes among those with different physical intervention frequencies and periods of exposure. We assessed whether changes in primary outcomes differed (moderated) by the period and category of physical intervention exposure. Of the patients (n = 1074) who completed the baseline questionnaire across both randomized controlled trials, 470 (44%) reported physical intervention use at baseline, 383 (38%) reported physical intervention use after treatment, and 363 (42%) reported physical intervention use at 3-month follow-up. On average, there were moderate-large reductions from baseline to after treatment with respect to all outcomes (Cohen's d = 0.36-0.82). For all outcomes, the interaction of time by physical intervention exposure was statistically nonsignificant. A substantial proportion of patients who participated in a psychologically informed pain management program were establishing, continuing, or stopping additional physical interventions. The frequency of and period of exposure to physical interventions did not appear to moderate treatment outcomes. Australian and New Zealand Clinical Trials Registry (ACTRN12613000252718 and ACTRN12615001003561). The website for registration information is https://www.anzctr.org.au.

Internet-Delivered Psychological Pain Management: A Prospective Cohort Study Examining Routine Care Delivery by a Specialist Regional Multidisciplinary Pain Service

Several clinical trials have demonstrated the effectiveness of internet-delivered psychological-based pain management programs (PMPs). However, to date, no large studies have reported the outcomes of PMPs when delivered by specialist multidisciplinary pain services in routine care. The present study reports (n = 653) the outcomes of an internet-delivered PMP provided as routine care by a specialist Australian regional pain service over a 6-year period. High levels of treatment commencement (85%) and completion (72%) were observed, with more than 80% of patients reporting they were satisfied with the intervention. Clinical improvements were observed from pretreatment to post-treatment (% change, 95% confidence intervals (CI)) in pain-related disability (8.8%; 4.5, 12.8), depression (28.4%; 23.0, 33.4), anxiety (21.9%; 14.6, 28.5), and pain intensity (7%; 3.5, 10.5), which were maintained to 3-month follow-up. At 3-month follow-up, 27% (23, 31), 46% (41, 51), 44% (39, 49), and 22% (19, 26) reported clinically meaningful (defined as ≥ 30%) improvements in pain-related disability, depression, anxiety, and pain intensity, respectively. These results were obtained with relatively little therapist time per patient (M = 30.0, (standard deviation) SD = 18.8) to deliver the intervention. The current findings highlight the potential of internet-delivered PMPs as part of the services provided by specialist pain services, particularly those servicing large geographical regions and for patients unable to travel to clinics for face-to-face care. PerspectiveThis study reports the outcomes of the routine delivery of an internet-delivered psychological PMP by a specialist pain service. The findings highlight the potential of this model of care when provided by specialist pain services, particularly for patients not unable to attend and not requiring intensive face-to-face care.

The Impact of Multidisciplinary Educational Team-Based Clinical Nursing Pathway on the Psychological Resilience, Treatment Adherence, Pain Management and Quality of Life in Cancer Patients.

We aimed to investigate the impact of multidisciplinary educational team-based clinical nursing pathway on the psychological resilience, treatment adherence, pain management and quality of life in cancer patients. From 2019 to 2020, eighty two cancer patients were selected and randomly divided into the control group and the observational group. Both groups were treated with routine oncology nursing and the multidisciplinary educational team-based clinical nursing pathway, respectively. Psychological resilience, pain management and qualify of life were assessed by the Chinese version of the Connor-Davidson resilience scale, revised American Pain Society Patient Outcome Questionnaire and the Nottingham health profile, respectively. Treatment adherence was semi-quantitatively classified as "good", "fair" and "bad". Patient's psychological resilience, compliance, pain outcome and quality of life were similar between the control group and the observational group on admission. Patient's psychological resilience, compliance and pain outcome in the observational group were significantly superior to those in the control group one day prior to discharge and 2 months post-discharge (all P<0.05). The scores of energy, emotions, sleep and mobility were significantly different between the observational group and the control group one day prior to discharge and 2 months post-discharge (all P<0.05). Significant improvements were observed with regard to the scores of energy, sleep and mobility in the control group 2 months post-discharge, whereas the scores of energy, emotions, sleep and mobility improved dramatically in the observational group (all P<0.05). Compared with routine oncology nursing, multidisciplinary educational team-based clinical nursing pathway could improve patient's psychological resilience, treatment adherence, pain management and quality of life.

Internet-Delivered Psychological Pain-Management for Young Adults With Chronic Pain: An Investigation of Clinical Trial Data

Young adults report chronic pain at rates of around 12% but lack access to clinical services. There is interest in learning how this emerging adult population engages with and responds to treatment. Using data from young adults aged 18 to 30 years (Mage = 25.8, SD = 3.2), taken from 4 previous randomised controlled trials, the current study investigated the feasibility, acceptability, and efficacy of an internet-delivered psychological pain-management intervention for young adults with chronic pain. We compared young adults in a treatment group (n = 104) with 1) a young-adult wait-list control group (n = 48), and 2) a treatment group reflecting the average-aged participant from the previous trials (39–63 years, n = 561). Feasibility was determined through treatment engagement, adherence and completion, and acceptability through a treatment satisfaction measure. Clinical outcomes were disability, pain intensity, anxiety, and depression; assessed at pre-treatment, post-treatment, and 3-month follow-up. Generalised estimation equation analyses were undertaken, using multiple imputations to account for missing data. Young adults had high engagement and acceptability ratings, though 34% did not complete the intervention. The treatment group significant improved across all outcomes, compared with control, with improvements maintained at follow-up. Post-treatment improvements were equivalent for young-adult and average-aged adult treatment groups, with no significant differences in feasibility or acceptability outcomes. Findings indicate young adults can engage with and show improvements following a psychological pain-management intervention designed for all adults with chronic pain. Future research is encouraged to examine outcomes related to role functioning of young adults, and moderators of treatment acceptability and efficacy for this population. PerspectiveSecondary analysis of data from 4 RCTs found an Internet-delivered psychological pain-management intervention acceptable and clinically efficacious for improving disability, anxiety, depression and pain intensity in young adults (18–30) with chronic pain.

Evaluation of a therapist-guided virtual psychological pain management program when provided as routine care: a prospective pragmatic cohort study.

Numerous randomized controlled trials have evaluated the outcomes of internet-delivered psychological pain management programs (PMPs) as a way of increasing access to care for people with chronic pain. However, there are few reports of the effectiveness of these PMPs when provided as part of routine care. The present study sought to report the clinical and demographic characteristics of users (n = 1367) and examine the effectiveness of an established internet-delivered psychological PMP program in improving several pain-related outcomes, when offered at a national digital mental health service over a 5-year period. It also sought to comprehensively explore predictors of treatment commencement, treatment completion, and clinical improvement. Evidence of clinical improvements (% improvement; Hedges g) were found for all outcomes, including pain interference (18.9%; 0.55), depression (26.1%; 0.50), anxiety (23.9%; 0.39), pain intensity (12.8%; 0.41), pain self-efficacy (-23.8%; -0.46) and pain-catastrophizing (26.3%; 0.56). A small proportion of users enrolled but did not commence treatment (13%), however high levels of treatment completion (whole treatment = 63%; majority of the treatment = 75%) and satisfaction (very satisfied = 45%; satisfied = 37%) were observed among those who commenced treatment. There were a number of demographic and clinical factors associated with commencement, completion and improvement, but no decisive or dominant predictors were observed. These findings highlight the effectiveness and acceptability of internet-delivered psychological PMPs in routine care and point to the need to consider how best to integrate these interventions into the pathways of care for people with chronic pain.

The Timing and Magnitude of Improvements in Depression, Anxiety, Disability, and Pain Intensity During an Internet-delivered Program for Chronic Pain

Numerous studies have found that pain management programs are an effective treatment option for people with chronic pain. However, little is known about when people experience improvements during these programs and why they are effective. Using a secondary analysis, the current study examined the timing and magnitude of symptom change during an 8-week internet-delivered psychological pain management program for people with chronic pain. The change in 4 outcomes was examined: depression (n = 881), anxiety (n = 561), disability (n = 484), and pain intensity (n = 484). The largest improvements in depression, anxiety, and disability were reported during the first half of treatment (ie, 4 weeks), whereas the largest reductions in pain intensity were reported during the second half of treatment. Half the participants had experienced a clinically meaningful improvement in depression or anxiety, and a third of participants had reported such an improvement in disability by midtreatment (ie, 5 weeks after baseline). In a subgroup analysis (n = 397), this pattern of change in depression and anxiety symptoms did not differ based on the level of therapist guidance. This study highlights the importance of the first few weeks of psychological pain management programs and encourages future work to examine how the mechanisms underpinning rapid change may be harnessed to optimize care for people with chronic pain. PerspectiveThis study found that depression, anxiety, and disability improved rapidly during the first half of an 8-week internet-delivered pain management program, and most of the prepost change had occurred by midtreatment. This work highlights the therapeutic potential of the first few treatment sessions and prompts future research into a rapid responding.

Utilization, Delivery, and Outcomes of Dance/Movement Therapy for Pediatric Oncology Patients and their Caregivers: A Retrospective Chart Review.

Children with cancer and their caregivers face physical and psychosocial challenges during and after treatment. Dance/movement therapy (DMT) has been used to improve well-being, promote healthy coping, and mitigate the impact of illness, but limited knowledge exists regarding DMT utilization, delivery, and outcomes in pediatric oncology. This retrospective study aimed to identify reasons for referral to DMT, DMT visit characteristics, key DMT techniques and processes, and clinician-reported outcomes. We examined the electronic medical records of 100 randomly selected pediatric patients (resulting in 1160 visits) who received DMT services between 2011 and 2021. Sociodemographic, clinical, and visit characteristics, referral reasons, and clinician-reported outcomes were reported as frequency and proportions. Qualitative thematic analysis was used to identify key DMT techniques and processes. Among 100 patients (63% female, aged 0-27 years), 77.9% were referred for psychological distress and 19.6% for pain. Two distinct DMT approaches were used during visits: a traditional DMT approach (77%) and a multisensory DMT approach (23%). The most common visit length was 15-25 min (41.6%), followed by sessions of 30-45 min (22.5%) and ≤10 min (18.1%). A total of 61.9% of DMT visits were inpatient and 38.1% outpatient. Of all visits, 8.8% were new and 91.2% were follow-ups. Caregivers were engaged in treatment in 43.7% of visits, and 5.5% of visits focused entirely on the work with the caregiver. DMT intervention focused on self-expression, emotional self-regulation, coping strategies, socialization, and caregiver-child interaction. Clinician-reported outcomes included enhanced coping with hospital experience (58%), improved pain management (27%), improved self-regulation (21%), and increased physical activation (13.2%). The results suggest DMT as a supportive intervention for psychological distress and pain management in pediatric oncology patients and provide insights into DMT practices and outcomes to guide intervention development and future research.

Positive well-being and usefulness of brief mindfulness-based intervention for pain in cancer

ABSTRACT Background and Aim: The experience of pain is a pivotal issue in the management of cancer. It has a detrimental impact on the overall well-being of the patients. Psychological management of pain remains an oblivious component of pain management in health-care facilities. The main aim of the study was to explore the relationship between positive well-being variables positive emotion, engagement, relationship, meaning &amp; accomplishment (PERMA) with pain perception in persons suffering from cancer pain and to investigate the usefulness of brief mindfulness-based intervention in reducing cancer pain. Methods: Single group quasi experimental pre-to postintervention design was employed and 30 adult participants of any gender diagnosed with any cancer except lung cancer with breathing difficulties reporting pain were recruited. The tools administered were Mini International Neuropsychiatric Interview (to screen the presence of any psychiatric illness) PERMA Profiler (only at baseline), Brief Pain Inventory, Pain Catastrophizing Scale, and Cognitive and Affective Mindfulness Scale-Revised before the intervention and at 4 weeks following brief mindfulness-based intervention for cancer pain (BMBI-CP). Results: The findings indicate that among positive well-being variable (PERMA), the domain of relationship was found to be in a slightly higher range in comparison to other domains. There was a statistically significant difference found in the values of pain severity (t = 6.09, P &lt; 0.01), pain interference (t = 7.79, P &lt; 0.01), pain catastrophization (t = 4.68, P &lt; 0.01), rumination (t = 5.20, P &lt; 0.01), magnification (t = 3.03, P &lt; 0.01), helplessness (t = 4.19, P &lt; 0.01), and mindfulness traits (t = −2.82, P &lt; 0.01) post intervention (BMBI-CP). Conclusion: Brief mindfulness-based intervention is useful in terms of the ease of delivery and managing psychological aspects of pain perception. Positive well-being variables are significantly associated with pain perception, which would help in the further therapeutic management of cancer pain.

A Critical Investigation of the Role of Psychological Pain Management on Successful Paediatric Physiotherapy and Rehabilitation

A Critical Investigation of the Role of Psychological Pain Management on Successful Paediatric Physiotherapy and Rehabilitation

Managing neuropathic pain through hypnosis among diabetics

Background &amp; Objective: The global prevalence of diabetes is increasing with a variety of physiological, psychosomatic, and psychological manifestations. Literature review is evident in favor of modern psychological therapies, including hypnosis with circle therapy, which has been proven effective for the management of many such problems. We aimed to assess the effects of hypnosis on neuropathic pain management among diabetics, for this purpose, a manualized intervention plan was developed comprising hypnosis suggestions using circle therapy. Methodology: In this study, 20 diabetics (Type-1 and Type-2) ages 40−60 y, were selected through a non-probability purposive sampling technique. One group pre-test/post-test experimental research design was used. A demographic questionnaire, and Douleur Neuropathic pain rating scale (DN-4), was used for pre- and post-assessment of the patients. Results: Data obtained were analyzed through SPSS-21, t-test was used for the analysis of the results. Pre- and post-session assessment was done. After pre-assessment two hypnosis sessions along with circle therapy were administered to the patient. After the application of therapy, post-assessment was done, and it was seen that the hypnosis along with circle therapy had significant (P &lt; 0.05) effect for diabetic neuropathic pain management among diabetics. Conclusion: From the current study and the literature review, it is concluded that diabetic neuropathic pain is manageable through hypnosis and circle therapy. Hypnosis and circle therapy is an effective technique for psychological pain management as it is a brief and less costly technique that can be applied without any side effects. It showed short-term effects but can be prolonged with multiple sessions of circle therapy. Abbreviations: DM - Diabetes Mellitus; DN-4 - Douleur Neuropathic Scale-4; DPN – Diabetic Peripheral Neuropathy. Keywords: Neuropathic Pain; Diabetes Mellitus; Hypnosis; Circle Therapy Citation: Kubra K, Rafiq M, Adnan M. Managing neuropathic pain through hypnosis among diabetics. Anaesth. pain intensive care 2023;27(3):338−342; DOI: 10.35975/apic.v27i3.1720 Received: December 16, 2021; Reviewed: January 20, 2022; Accepted: February 13, 2023

The impact of physical and psychological pain management training on pain intensity, anxiety and disability in patients undergoing lumbar surgeries

BACKGROUND/CONTEXTLumbar surgery is one of the interventions performed for patients with degenerative conditions. PURPOSEThis study aimed to investigate the effect of pain management education on pain intensity, anxiety, and disability after the lumbar surgery. STUDY DESIGN/SETTINGThis randomized controlled trial was performed on 70 30-65-year-old patients with lumbar canal stenosis and lumbar disc herniation from 2018 to 2019. PATIENT SAMPLESeventy participants were randomly divided into a control and an intervention group by a randomized block design. Participants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions. OUTCOME MEASURESAll participants in the two groups completed the study instruments (numeric rating scale [NRS], Oswestery disability index [ODI], and pain anxiety symptoms scale [PASS]) before, immediately after, and 3 months after the study. METHODSParticipants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions. To analyze the treatment effects, repeated-measures multivariate analysis of variance (MANOVA) and effect sizes were used where appropriate and calculated by Partial ɳ2. Clinical outcome (MDC) for pain intensity and PASS was also reported. For participants lost to follow-up, we also used an “intention-to-treat” (ITT) approach. RESULTSThe results of MANOVA indicated that there were significant differences between the two groups on ratings of pain intensity, anxiety, and disability. According to the MDC, the mean differences of pain intensity for the intervention group was also clinically improved. Meanwhile, the mean differences in pain anxiety between three different times in the two groups were not above the MDC (20.14), suggesting that the clinical improvements were not significant. The results were confirmed for all outcome measures; a statistically significant difference was found between the groups in ITT analyses (p<.001). CONCLUSIONSPhysical and psychological pain management education was shown to be effective in decreasing pain intensity, anxiety, and disability. This strategy may be beneficial for such patients. Variables such as smoking behavior, past history of psychological disorders, and previous surgeries should be considered in future studies.

A Critical Investigation of the Role of Psychological Pain Management on Successful Paediatric Physiotherapy and Rehabilitation

Physical pain in children has been identified by multiple evidences of research as a source of discomfort among children that can even limit their reception of other medical treatment. In this study, effort is made to highlight the role of physiotherapy in psychological pain management in children and how it helps in improving pain management for better treatment and rehabilitation. The current study examined evidences of literature from over 30 authoritative sources made up mostly of authoritative journals in the medical field of physiotherapy with specific focus on paediatric physiotherapy. The research sought to extract evidence of the different needs of children when it comes to pain management and how physiotherapy practice can be effectively deployed in the management of pain among children both from a psychological and physical point of view. The findings of the research highlighted the important role that physiotherapy with specific focus on psychological capabilities of physiotherapist to identify pain in children and effectively manage it. This was noted to assist children in their rehabilitation process post injury including but not limited to the positive uptake of other treatment such as surgery.

The role of catastrophizing in chronic cyclical pelvic pain: A systematic review and meta-analysis.

Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of another medical condition, including endometriosis and chronic pelvic pain. Research examining the relationship between menstrual pain ratings and catastrophizing has produced mixed results. To review and meta-analyze the relationship between catastrophizing and pain ratings of chronic cyclical pelvic pain. Cross-sectional, longitudinal, and intervention studies that reported the relationship between menstrual/pelvic pain and catastrophizing were included. Study populations had to include healthy menstruating persons or persons with a condition associated with cyclical pelvic pain including primary dysmenorrhea, endometriosis, and/or chronic pelvic pain. A systematic search of articles published since 2012 on PubMed, PsychInfo, CINHAL, and Medline was conducted in January and rerun in November of 2022. Search terms included cyclical pelvic pain, dysmenorrhea, endometriosis, pelvic pain, and catastrophizing. Data extraction was completed independently by two extractors and cross-checked for errors. A random-effects meta-regression was used to synthesize the data using restricted maximum likelihood. Twenty-five studies examining 4,540 participants were included. A random effects model found a meta-correlation between catastrophizing and pain of r = .31 (95% confidence interval: .23-.40) p < .001. Heterogeneity was large and significant (I2 = 84.5%, Q(24) = 155.16, p < .001). Studies that measured general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain had significantly higher correlations. Age and depression did not moderate the relationship between catastrophizing and pain. A systematic review and meta-analysis found that catastrophizing had a small but significant positive association with pain ratings. Patients experiencing cyclical pelvic pain may benefit from interventions targeting the psychological management of pain. This meta-analysis was registered in PROSPERO on 14 January 2022. Registration number: CRD42022295328.

Pain hygiene: A content analysis of student nurses' perspectives.

Pain hygiene (PH) is a new concept that has not been well-defined. A qualitative content analysis was conducted to understand this newly developed concept. Based on the responses from 78 students, the perceptions of the meaning of the term "pain hygiene" and differences between the term "pain hygiene" and "sleep hygiene" through their participation in open-ended surveys was described. Using content analysis, four themes emerged to present students' meaning of the term "pain hygiene": prevention of worsening of pain; cleanliness or hygiene practices to manage pain; self-care to manage pain; and physical and psychological management of pain. Two themes emerged illustrating differences between PH and sleep hygiene: practices that contribute to a better quality of life and condition, and better sleep with no pain. As a newly developing concept, PH can be used to make changes in pain assessment, prevention, and pain management strategies for all people with pain, which can enrich their quality of life and bring change in pain care outcomes.

Impact of Preoperative Psychological Intervention on Postoperative Outcomes in Adolescents Undergoing Reconstructive Surgery for Pectus Excavatum

Reconstructive surgery for pectus excavatum (PE) is known to be associated with distress and postoperative pain. Non-pharmacological interventions, including education and coping skills for worry and postoperative pain are needed, but lacking. This study examined the initial effectiveness of a novel, preoperative, psychological intervention for adolescents undergoing surgery for PE. A one-hour psychological intervention focused on teaching participants coping "tools" for pain and worry was developed specifically for this patient population. A clinician-developed survey assessed participant (n=26, Mean Age = 15 years) and caregiver (n=21) satisfaction with, and perceived benefit of, the intervention. Intervention participants were compared against historical controls (n=20) on in-hospital and post-discharge outcomes: daily opioid consumption, PCA use, pain scores, medication refills, and frequency of clinic phone calls. Participants reported a high degree of satisfaction (95%) and benefit (100%). Most used the pain management tools (86%) but not tools for worry (52%, denying worry). Caregivers also reported a high degree of satisfaction (95%) and benefit (100%). Most caregivers reported that their child benefitted from pain management tools (95%), but fewer reported benefit from tools for worry (70%, denying worry in their child). No significant differences were found between participants and controls on outcomes with one exception: Participants consumed more opioid than controls on post-op Day 0, both with (p = 0.023) and without (p = 0.015) considering intraoperative opioids. Participants and caregivers perceived high satisfaction and benefit from the psychological intervention. In contrast to hypotheses, however, patients and caregivers denied a need to manage surgery-related worry. Also unexpectedly, the intervention did not result in opioid sparing. It is plausible that the intervention increased comfort with using opioids, but further research is needed to understand the interplay of pharmacological and psychological pain management tools in adolescents.

Evaluation of About Face: A Psychology and Physiotherapy Pain Management Program for Adults with Persistent Facial Pain.

To evaluate About Face, a pain management program aimed at increasing quality of life in adults living with persistent facial pain through psychology- and physiotherapy-based skill development. A total of 90 patients attended a six-session program with a 1-month follow-up between 2015 and 2019. Patients filled out self-reported outcome measures preprogram, postprogram, and at a 1-month follow-up visit. There was a significant reduction in pain catastrophizing and a significant increase in engagement in meaningful activity, as well as a reduction in pain-related interference. This evaluation adds to the small amount of existing literature on interventions aimed at increasing quality of life in patients living with persistent facial pain and provides suggestions for future research.

What does low psychological distress mean in patients with no mental disorders and different pains of the musculoskeletal system?

The aim of this study is to define the different levels of psychological distress in patients suffering from pain and functional disorders of the musculoskeletal system. This investigation was conducted as a retrospective study of 60 patients randomly selected of a German specialized orthopaedic hospital within the year 2016, whose therapeutic approaches are based on a non-surgical orthopaedic multimodal approach of manual therapy. All patients were suffering from pain and functional disorders of the musculoskeletal system. Two groups were formed: one without and one with additional mental disorders according to ICD-10. The impairment score (ISS) according to Schepank was determined. The somatic sub score of the ISS was the highest sub score in both patient groups. The cumulative value of the ISS score of patients with both a mental disorder and pain in the musculoskeletal system was higher than for patients without concomitant mental disorder. For patients without concomitant mental disorder, the cumulative ISS exceeded the test criteria for mentally healthy individuals. Patients without mental disorder but with chronic pain of the locomotoric system receive a psychological pain management program, as it is part of the billing code OPS 8-977 to the health insurance companies in Germany. However, the data show that these patients also have a substantial somatic subscore and a cumulative ISS above the level of healthy individuals. The absence of psychological disorders (according to ICD-10) in patients with pain ofthe musculoskeletal system should not lead to the assumption that these patients are psychologically inconspicuous. Subsyndromal mental findings (below ICD-10) can be one aspect of a mental disorder presenting with primarily somatic symptoms. In this case, patients would benefit from a psychotherapeutic program in a similar way as the patients with mental disorders according to ICD-10.

A Retrospective Study of Traffic Accident Inpatients in a Korean Medicine Hospital: Correlation of STAI-Ⅰ, STAI-Ⅱ, BDI, and CSEI-s scores with Pain Improvement

Objectives: The objective of this study was to investigate the correlation of the scores on the State-Trait Anxiety Inventory-Ⅰ (STAI-Ⅰ), State-Trait Anxiety Inventory-Ⅱ (STAI-Ⅱ), Beck’s Depression Inventory (BDI), and Core Seven Emotions Inventory-short form (CSEI-s) scales with pain improvement. Methods: We retrospectively investigated the medical records of 66 traffic accident inpatients who satisfy the selection criteria. They had received Korean medical treatment including acupuncture, electroacupuncture, pharmacopuncture, herbal medicine, and Chuna during hospitalization. STAI-Ⅱ, BDI, and CSEI-s scores on hospital day 1, and STAI-Ⅰ and numerical rating scale(NRS) scores on hospital day 1, 4, 7, and 10 were used for analysis. Pain improvement was evaluated by difference in NRS scores between hospital day 1 and hospital day 4, 7, 10. Results: The STAI-Ⅰ, BDI, and CSEI-s scores showed significant correlations with pain or pain improvement. Conclusions: This study may be used in the research on psychological state and pain management of traffic accident patients and for patient education. Large-scale, well-designed studies need to be conducted in future to strengthen the results in this regard.

Intraoperative panic attack in patients undergoing awake craniotomy: a retrospective analysis of risk factors.

Intraoperative anxiety is the most common psychological response of the patient during awake craniotomy. Psychological stress can trigger patient decline, resulting in failed awake craniotomy and significantly poor outcomes. This study aimed to identify the risk factors for panic attack (PA) during awake craniotomies. With the local ethics committee approval, we conducted a manual chart review of the medical record of patients who underwent consecutive awake craniotomies between November 1999 and October 2016 at Tokyo Women's Medical University. A total of 405 patients were identified and assigned to 2 groups based on the Diagnostic and Statistical Manual of Mental Disorders-V criteria: those that met the PA criteria (Group PA) and those that did not (Group non-PA). Patient characteristics and the incidence of the PA specifier were collected. The features of the two groups were statistically compared, and risk factors for PA occurrence were determined by regression analysis. Sixteen of 405 patients met the diagnostic criteria of PA. Patients' characteristics were not statistically different between the groups. Multivariate logistic regression showed that intraoperative anxiety (p = 0.0002) and age younger than 39years (as opposed to age > = 39years; p = 0.0328) were significantly associated with the occurrence of PA during awake craniotomy. For patients undergoing awake craniotomy, intraoperative anxiety and age younger than 39years were considered risk factors of PA. As PA often necessitates conversion to general anesthesia, intensive perioperative psychological support and pain management are required to achieve patient satisfaction and the surgical goal of awake craniotomy.