-
Headache is the most common pain problem in children and adolescents and, in a considerable proportion, a source of suffering and disability. Medical intervention mainly relies on abortive pharmacological agents (analgesics and antimigraine drugs). Psychological therapies aim at the prevention of headache episodes and the modifications of cognitive-emotional and cognitive-behavioral processes influencing pain. Three main forms of therapy have been evaluated in randomized controlled trials and reviewed in meta-analyses: relaxation training, biofeedback and multimodal cognitive-behavioral therapy. So far there is only scarce evidence on hypnosis and acceptance and commitment therapy, although they seem to be promising. Evidence demonstrates that psychological therapies are efficacious, and that clinically relevant improvement is found in approximately 70\% of the treated children at follow-up examination. Future research needs to focus on mechanisms of change, and to extend its view of effects induced by therapy beyond headache improvement to indicators of quality of life. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Psychologically based interventions such as relaxation training, biofeedback and cognitive-behavioural therapy are increasingly discussed as options for the treatment of migraine and tension-type headache in children and adolescents. In order to determine the state of evidence regarding the efficacy of these treatments, a meta-analysis of randomized controlled studies was conducted. In a comprehensive literature search including data from 1966 to 2004, 23 studies were found meeting the inclusion criteria. Due to the application of the random effects model, generalization of the results is possible. Specific statistical procedures were used to account for a possible publication bias. Significantly more patients improved to a clinically relevant extent (headache reduction ≥50\%) in treatment conditions compared with waiting list conditions (high effect sizes). Long-term stability was also confirmed. The analysed treatments lead to improvement (up to 1 year) in headache status in children and adolescents with primary headache. However, more well-designed studies are needed to support and consolidate the conclusions of this meta-analysis and to compare the effects of psychological treatment with those of prophylactic medical interventions (in migraine), to examine potential differences between treatments, to identify moderators of efficacy and to determine effects of treatment on other health-related variables such as quality of life. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Objective: Vertigo symptoms can lead to more or less vertigo-related handicap. This longitudinal study investigated whether depression, anxiety, and/or somatization mediate the relationship between vertigo symptoms and vertigo-related handicap. Methods: N = 111 patients with vertigo/dizziness provided complete data on the following measures: Vertigo symptoms at baseline, depression at 6-month follow-up, anxiety at 6-month follow-up, somatization at 6-month follow-up, and vertigo handicap at 12-month follow-up. Mediation analyses with bootstrapping were performed to investigate the mediating role of anxiety, depression, and somatization in the relationship between vertigo symptoms and vertigo-related handicap. Results: When the mediating role of anxiety, depression, and somatization was evaluated separately from each other in single mediation models, the effect vertigo symptoms at baseline exerted on vertigo-related handicap at 12-month follow-up was significantly mediated by depression at 6-month follow-up (p < 0.05), by anxiety at 6-month follow-up (p < 0.05), as well as by somatization at 6-month follow-up (p < 0.05). When statistically controlling for the other mediators in a multiple mediator model, only depression at 6-month follow-up mediated the effect of vertigo symptoms at baseline on vertigo-related handicap at 12-month follow-up (p < 0.05). Conclusion: Psychological distress is an important mechanism in the process how vertigo symptoms lead to vertigo-related handicap. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
-
According to self-report and unsystematic observational data adult patients with attention-deficit/hyperactivity disorder suffer from increased vulnerability to daily life stressors. The present study examined psychological and physiological stress responses in adult ADHD subjects in comparison to healthy controls under laboratory conditions. Thirty-six subjects (18 patients with DSM-IV ADHD diagnosis, 18 sex- and age-matched healthy controls) underwent the Trier Social Stress Test (TSST; Kirschbaum, C., Pirke, K.-M., Hellhammer, D.H., 1993. The 'Trier Social Stress Test'–a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 28, 76-81), a standardized psychosocial stress protocol which contains a stress anticipation phase and a stress phase with a free speech assignment and subsequent performance of a mental arithmetic. Physiological stress measures were salivary cortisol as an indicator of the HPA axis, heart rate (HR), and time- and frequency-domain heart rate variability (HRV) parameters. Subjective stress experience was measured via self-report repeatedly throughout the experimental session. In line with previous theoretical and empirical work in the field of childhood ADHD, it was hypothesized that the ADHD and control group would exhibit comparable baseline levels in all dependent variables. For ADHD subjects, we expected attenuated responses of the physiological parameters during anticipation and presence of the standardized stressor, but elevated subjective stress ratings. Hypotheses were confirmed for the baseline condition. Consistent with our assumptions in regard to the psychological stress response, the ADHD group experienced significantly greater subjective stress. The results for the physiological variables were mixed. While ADHD subjects revealed an attenuated HR during the stress phase, no significant group differences were found for the other parameters, although a trend was observed for both the low frequency/high frequency (LF/HF) ratio of the HRV power spectral analysis and salivary cortisol (the latter possibly indicating generally lower cortisol levels in ADHD subjects). In summary, the present findings are the first to demonstrate a significant alteration of a specific physiological stress measure (HR) and, more clearly, of psychological aspects of the stress response in adults suffering from ADHD. In regard to the physiological stress response, it is recommended that future studies employ larger sample sizes and a more comprehensive range of physiological stress parameters. Additionally, the issue of transferability of laboratory results to real life stressors needs to be addressed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Objective: A prospective four-year study examined which components of addiction severity predicted time to relapse among 112 adults with chronic alcoholism who participated in a comprehensive outpatient treatment program. Methods: Recruited from emergency, inpatient, and outpatient facilities, patients were admitted into the program consecutively between March 1998 and June 2002. Alcohol abstinence was carefully monitored for four years from admission by regular contacts and urine and blood analyses. Alcoholism characteristics and personality disorders were assessed with structured interviews and the International Diagnostic Checklists for Personality Disorders. Results: Among a variety of potential variables, only presence of a personality disorder and chronicity of addiction were independently associated with a decrease of cumulative four-year abstinence probability. Conclusions: Their high predictive values suggest that chronicity and personality disorder rank among the most important characteristics of addiction severity. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
For understanding the heterogeneity of tinnitus, large samples are required. However, investigations on how samples recruited by different methods differ from each other are lacking. In the present study, three large samples each recruited by different means were compared: N=5017 individuals registered at a self-help web platform for tinnitus (crowdsourcing platform Tinnitus Talk), N=867 users of a smart mobile application for tinnitus (crowdsensing platform TrackYourTinnitus), and N=3786 patients contacting an outpatient tinnitus clinic (Tinnitus Center of University Hospital Regensburg). The three samples were compared regarding age, gender, and duration of tinnitus (month or years perceiving tinnitus; subjective report) using chi-squared tests. The three samples significantly differed from each other in age, gender, and tinnitus duration (p<.05). Users of the TrackYourTinnitus crowdsensing platform were younger, users of the Tinnitus Talk crowdsourcing platform had more often female gender, and users of both newer technologies (crowdsourcing and crowdsensing) had more frequently acute/subacute tinnitus (<3 months and 4-6 months) as well as a very long tinnitus duration (>20 years). Implications of these findings for clinical research are that newer technologies such as crowdsourcing and crowdsensing platforms offer the possibility to reach individuals hard to get in contact with at an outpatient tinnitus clinic. Depending on the aims and the inclusion / exclusion criteria of a given study, different recruiting strategies (clinic and / or newer technologies) offer different advantages and disadvantages. In general, study results might be increased when tinnitus study samples are recruited in the clinic as well as via crowdsourcing and crowdsensing.
-
The aims of the present study were the assessment of headache (HA) prevalence in German children and adolescents in the second year of a 4-year longitudinal study and the analysis of headache status change from year 1 to year 2. The original sample consisted of 8,800 households with a child aged 7-14 years. A total of 4,159 households responded in both year 1 and year 2, yielding 3,984 valid parent questionnaires. Data regarding various aspects of the child's HA history and general health were gathered via mailed questionnaires from the parents. Of the households returning valid parent questionnaires at survey 2, 48.9\% reported their child to have experienced headaches during the previous 6 months (53\% at survey 1). Weekly HA was reported for 6.5\% of the children, monthly or less frequent HA for 16.5\% and 25.9\%, respectively. With regard to headache diagnosis, 55.0\% of the children and adolescents with HA experienced tension-type HA (TTH) and 11.3\% migraine with or without aura (M). For more than half of the children and adolescents with HA (57.0\%) the frequency of head pain remained stable over the period of 1 year (i.e. same frequency category in years 1 and 2). Improved and worsened HA status regarding frequency of occurrence was found in 22.3\% and 20.7\% of the subjects, respectively. Thus, there was no definite trend towards an increase of HA episodes over the course of 1 year regarding the individual child or adolescent. The most stable type of HA was TTH. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
-
Background: A large number of population-based studies of chronic pain have considered neuropathic sensory symptoms to be associated with a high level of pain intensity and negative affectivity. The present study examines the question of whether this association previously found in non-selected samples of chronic pain patients can also be found in chronic pain patients with underlying pathology of neuropathic sensory symptoms. Methods: Neuropathic sensory symptoms in 306 patients with chronic pain diagnosed as typical neuropathic pain, radiculopathy, fibromyalgia, or nociceptive back pain were assessed using the Pain DETECT Questionnaire. Two separate cluster analyses were performed to identify subgroups of patients with different levels of self-reported neuropathic sensory symptoms and, furthermore, to identify subgroups of patients with distinct patterns of neuropathic sensory symptoms (adjusted for individual response bias regarding specific symptoms). Results: ANOVA (analysis of variance) results in typical neuropathic pain, radiculopathy, and fibromyalgia showed no significant differences between the three levels of neuropathic sensory symptoms regarding pain intensity, pain chronicity, pain catastrophizing, pain acceptance, and depressive symptoms. However, in nociceptive back pain patients, significant differences were found for all variables except pain chronicity. When controlling for the response bias of patients in ratings of symptoms, none of the patterns of neuropathic sensory symptoms were associated with pain and psychological factors. Conclusion: Neuropathic sensory symptoms are not closely associated with higher levels of pain intensity and cognitive-emotional evaluations in chronic pain patients with underlying pathology of neuropathic sensory symptoms. The findings are discussed in term of differential response bias in patients with versus without verified neuropathic sensory symptoms by clinical examination, medical tests, or underlying pathology of disease. Our results lend support to the importance of using adjusted scores, thereby eliminating the response bias, when investigating self-reported neuropathic symptoms by patients. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Alzheimer's disease is a neurodegenerative disorder characterized by extracellular amyloid plaque deposits, mainly composed of amyloid-beta peptide and intracellular neurofibrillary tangles consisting of aggregated hyperphosphorylated tau protein. Amyloid-beta represents a neurotoxic proteolytic cleavage product of amyloid precursor protein. The progressive cognitive decline that is associated with Alzheimer's disease has been mainly attributed to a deficit in cholinergic neurotransmission due to the continuous degeneration of cholinergic neurons e.g. in the basal forebrain. There is evidence suggesting that other neurotransmitter systems including neuronal histamine also contribute to the development and maintenance of Alzheimer's disease-related cognitive deficits. Pathological changes in the neuronal histaminergic system of such patients are highly predictive of ensuing cognitive deficits. Furthermore, histamine-related drugs, including histamine 3 receptor antagonists, have been demonstrated to alleviate cognitive symptoms in Alzheimer's disease. This review summarizes findings from animal and clinical research on the relationship between the neuronal histaminergic system and cognitive deterioration in Alzheimer's disease. The significance of the neuronal histaminergic system as a promising target for the development of more effective drugs for the treatment of cognitive symptoms is discussed. Furthermore, the option to use histamine-related agents as neurogenesis-stimulating therapy that counteracts progressive brain atrophy in Alzheimer's disease is considered. This article is part of a Special Issue entitled ‘Histamine Receptors’.
-
Chronic tinnitus affects approximately 5\% of the population. Severe distress due to the phantom noise is experienced by 20\% of the tinnitus patients. This distress cannot be predicted by psychoacoustic features of the tinnitus. It is commonly assumed that negative cognitive emotional evaluation of the tinnitus and its expected consequences is a major factor that determines the impact of tinnitus-related distress. Models of tinnitus distress and recently conducted research propose differences in limbic, frontal and parietal processing between highly and low distressed tinnitus patients. An experimental paradigm using verbal material to stimulate cognitive emotional processing of tinnitus-related information was conducted. Age and sex matched highly (n = 16) and low (n = 16) distressed tinnitus patients and healthy controls (n = 16) underwent functional magnetic resonance imaging (fMRI) while sentences with neutral, negative or tinnitus-related content were presented. A random effects group analysis was performed on the basis of the general linear model. Tinnitus patients showed stronger activations to tinnitus-related sentences in comparison to neutral sentences than healthy controls in various limbic/emotion processing areas, such as the anterior cingulate cortex, midcingulate cortex, posterior cingulate cortex, retrosplenial cortex and insula and also in frontal areas. Highly and low distressed tinnitus patients differed in terms of activation of the left middle frontal gyrus. A connectivity analysis and correlational analysis between the predictors of the general linear model of relevant contrasts and tinnitus-related distress further supported the idea of a fronto-parietal-cingulate network, which seems to be more active in highly distressed tinnitus patients. This network may present an aspecific distress network. Based on the findings the left middle frontal gyrus and the right medial frontal gyrus are suggested as target regions for neuromodulatory approaches in the treatment of tinnitus. For future studies we recommend the use of idiosyncratic stimulus material. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
The fear-avoidance model postulates that in chronic low back pain (CLBP) a fear of movement is acquired in the acute phase, which leads to subsequent avoidance of physical activity and contributes to the pain syndromeʼs becoming chronic. In the present event-related functional magnetic resonance imaging (fMRI) study of the neural correlates of the fear of movement, 60 women (30 CLBP patients, 15 healthy controls, and 15 women with spider phobia; mean age 46.8 ± 9.8 years) participated. The CLBP patients were divided into a high and low fear-avoidant group on the basis of the Tampa Scale of Kinesiophobia. The participants viewed photographs depicting neutral and aversive (back-stressing) movements, generally fear-inducing and neutral pictures from the International Affective Picture System, and pictures of spiders while fMRI data were acquired. It was hypothesized that the high fear-avoidant CLBP patients would show fear-related activations when viewing the aversive movements and that they would differ from CLBP patients with low fear-avoidance and controls in this regard. No such activations were found for high or low fear-avoidant CLBP patients. The random-effects analysis showed no differences between high and low fear-avoidant CLBP patients or high fear-avoidant CLBP patients and controls. Normal fear-related activations were present in the high fear-avoidant CLBP patients for the generally fear-inducing pictures, demonstrating the validity of the stimulation paradigm and a generally unimpaired fear processing of the high fear-avoidant CLBP patients. Our findings do not support the fear component of the fear avoidance model. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Background: Neuroimaging studies have demonstrated that the actual experience of pain and the perception of another person in pain share common neural substrates, including the bilateral anterior insular cortex and the anterior midcingulate cortex. As many fMRI studies include the exposure of participants to repeated, similar stimuli, we examined whether empathic neural responses were affected by habituation and whether the participants' prior pain experience influenced these habituation effects. Method: In 128 trials (four runs), 62 participants (31 women, 23.0 ± 4.2 years) were shown pictures of hands exposed to painful pressure (pain pictures) and unexposed (neutral pictures). After each trial, the participants rated the pain of the model. Prior to the experiment, participants were either exposed to the same pain stimulus (pain exposure group) or not (touch exposure group). In order to assess possible habituation effects, linear changes in the strength of the BOLD response to the pain pictures (relative to the neutral pictures) and in the ratings of the modelʼs pain were evaluated across the four runs. Results: Although the ratings of the modelʼs pain remained constant over time, we found neural habituation in the bilateral anterior/midinsular cortex, the posterior midcingulate extending to dorsal posterior cingulate cortex, the supplementary motor area, the cerebellum, the right inferior parietal lobule, and the left superior frontal gyrus, stretching to the pregenual anterior cingulate cortex. The participantʼs prior pain experience did neither affect their ratings of the modelʼs pain nor their maintenance of BOLD activity in areas associated with empathy. Interestingly, participants with high trait personal distress and fantasy tended to show less habituation in the anterior insula. Conclusion: Neural structures showed a decrease of the BOLD signal, indicating habituation over the course of 45 minutes. This can be interpreted as a neuronal mechanism responding to the repeated exposure to pain depictions, which may be regarded as functional in a range of contexts. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
The fear-avoidance model postulates that in an initial acute phase chronic low back pain (CLBP) patients acquire a fear of movement that results in avoidance of physical activity and contributes to the pain becoming chronic. The current functional magnetic resonance imaging study investigated the neural correlates of imagining back-straining and neutral movements in CLBP patients with high (HFA) and low fear avoidance (LFA) and healthy pain-free participants. Ninety-three persons (62 CLBP patients, 31 healthy controls; age 49.7 ± 9.2 years) participated. The CLBP patients were divided into an HFA and an LFA group using the Tampa Scale of Kinesiophobia. The participants viewed pictures of back-straining and neutral movements and were instructed to imagine that they themselves were executing the activity shown. When imagining back-straining movements, HFA patients as well as healthy controls showed stronger anterior hippocampus activity than LFA patients. The neural activations of HFA patients did not differ from those of healthy controls. This may indicate that imagining back-straining movements triggered pain-related evaluations in healthy controls and HFA participants, but not in LFA participants. Although heightened pain expectancy in HFA compared with LFA patients fits well with the fear-avoidance model, the difference between healthy controls and LFA patients was unexpected and contrary to the fear-avoidance model. Possibly, negative evaluations of the back-straining movements are common but the LFA patients use some kind of strategy enabling them to react differently to the back-straining events. Perspective: It appears that low fear-avoidant back pain patients use some kind of strategy or underlying mechanism that enables them to react with less fear in the face of potentially painful movements. This warrants further investigation because countering fear and avoidance provide an important advantage with respect to disability. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Objective: The aim of the study was to ascertain the prevalence of multiple pains (MPs) and detect psychosocial risk factors assessed 1 year previously. Method: MPs were defined by the number of sites where pain was reported to occur at least 'sometimes' in a general population sample of 2,219 German youths. Results: Two or more sites of recurrent pain were reported by 54\% of the participants, whereas 27\% reported no pains. Girls were much more prone to MPs than boys. Stability of MP was high in the two waves. Regression analysis revealed that prior MP, age, sex, internalizing/externalizing symptoms, and time spent with visual media explained 25\% of the variance: the contribution of the psychosocial factors to the model was small. Separate analyses for boys and girls displayed different risk-factor profiles and a higher degree of predictability in girls. Conclusion: A supposedly biological disposition, namely pain vulnerability, being particularly high in girls, is assumed to build the basis of pains felt in various sites of the body. Further research is needed to corroborate and specify these assumptions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Objective It is unclear whether observed memory impairment in anorexia nervosa (AN) depends on the semantic structure (categorized words) of material to be encoded. We aimed to investigate the processing of semantically related information in AN. Method Memory performance was assessed in a recall, learning, and recognition test in 27 adult women with AN (19 restricting, 8 binge-eating/purging subtype; average disease duration: 9.32 years) and 30 healthy controls using an extended version of the Rey Auditory Verbal Learning Test, applying semantically related and unrelated word stimuli. Results Short-term memory (immediate recall, learning), regardless of semantics of the words, was significantly worse in AN patients, whereas long-term memory (delayed recall, recognition) did not differ between AN patients and controls. Discussion Semantics of stimuli do not have a better effect on memory recall in AN compared to CO. Impaired short-term versus long-term memory is discussed in relation to dysfunctional working memory in AN. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
-
Pain research has shown that fear-avoidance beliefs determine disability from back pain to a significant degree. It is assumed that anxiety regarding certain movements or activities motivates avoidance behavior. It has not yet been established whether chronic low back pain (CLBP) patients actually experience fear of movement when confronted with back pain-related movements. Startle response measures reliably differentiate the affective quality of a stimulus. This study investigates whether CLBP patients show a startle response typical for aversive stimuli when confronted with pictures of back pain-related movements. In 36 patients with CLBP (mean age 45 yrs), 18 headache patients (mean age 45 yrs) and 18 healthy controls (mean age 43 yrs), the startle response was examined in the presence of pictures of back pain-related movements (e.g., bending) and pleasant movements. Back pain patients did not show the predicted startle potentiation when viewing back pain-related pictures, although they rated these pictures as more aversive than did the other two groups. Results may indicate that it is not fear of pain that motivates avoidance behavior and determines disability, but rather an individual's beliefs and attitudes concerning back stressing movements. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Describes the development and validation of the Inventory for Assessing Causal Attributions and Control Attributions in Chronic Pain Patients. The inventory includes 4 scales assessing psychological and medical attributions related to the cause of pain and the control of pain. Results from several studies confirm the overall validity of the inventory. (English abstract) (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
We report the results of a randomized controlled trial that compared the efficacy of an internet-based self-help treatment for paediatric headache including chat communication (cognitive-behavioural treatment, CBT) with an internet-based psychoeducation intervention (EDU). In the CBT group, significant pre- to post-treatment decreases were found for headache frequency and pain catastrophizing, but not for headache intensity or duration. In the EDU group none of the variables (frequency, intensity, duration, pain catastrophizing) showed improvement. No significant between group differences were found for headache variables and pain catastrophizing at post-treatment. The patients reported high satisfaction with the internet-based training and a good patient-trainer-alliance. Results were maintained at 6-month follow-up. Due to the small sample size, no general conclusions can be drawn regarding the efficacy of the internet-based training regarding the outcome variables, but the training was well accepted by patients. Further research is necessary to evaluate the therapeutic potential of such interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
-
Tested the hypothesis that a treatment package that includes medical care and cognitive-behavioral treatment is more effective than medical treatment alone. This refers to improvement in control over pain, coping strategies, and physical and mental disability. The program was conducted in a group setting in accordance with a treatment manual and consisted of 12 weekly 2.5-hr sessions. A 2-factor experiment with repeated measures on 1 factor was applied. 94 consecutive patients with low-back pain were randomly assigned to an experimental group having a combined medical and cognitive-behavioral treatment, or to a control group with medical treatment only. Assessments were taken pretreatment, posttreatment, and (in the treated group only) at a 6-mo followup. At each assessment, Ss kept a pain diary over a period of 4 wks, and filled in self-report questionnaires. The sample consisted of 36 experimental and 40 control Ss at posttreatment. Experimental Ss reported less pain, better control over pain, more pleasurable activities and feelings, less avoidance and less catastrophizing. In addition, disability was reduced in terms of social roles, physical functions, and mental performance. Results were maintained at followup. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
