Search

Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients' preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients., Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients' preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance., Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients' preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes., Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ 2 2 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ 2 2 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (r s {58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables., Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually., (©Michael Alexander Harnik, Alina Scheidegger, Larissa Blättler, Zdenek Nemecek, Thomas C Sauter, Andreas Limacher, Florian Reisig, Martin grosse Holtforth, Konrad Streitberger. Originally published in JMIR Formative Research (https://formative.jmir.org), 29.04.2024.)

As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively., (© 2023. The Author(s).)

We set out to replicate findings of significant (a) reductions in pain, psychological distress, and motivational incongruence (i.e., insufficient motive satisfaction) after interdisciplinary multimodal pain treatment and (b) associations between reductions in motivational incongruence (i.e., improved motive satisfaction) and decreases in psychological distress (Vincent et al., Journal of Clinical Psychology in Medical Settings 28:331-343, 2021). 475 Patients with chronic primary pain completed standardized self-reported questionnaires assessing motivational incongruence, psychological distress, pain intensity, and pain interference at intake and discharge from a tertiary psychosomatic university clinic. We used hierarchical linear models to analyze motivational incongruence's effects on psychological distress. We partially replicated Vincent et al.'s findings. Significant reductions in pain, psychological distress, and motivational incongruence after treatment were found. Reductions in motivational incongruence were associated with reductions in psychological distress. Similarly, a better motive satisfaction mediated the relationship between pain interference and psychological distress. Our findings show that reducing motivational incongruence may be a key component of treating chronic primary pain; we recommend to assess and target motivational incongruence to improve interdisciplinary multimodal pain treatment., (© 2023. The Author(s).)

Objectives: To develop individual and effective treatment plans for patients with chronic pain, we aimed to replicate Grolimund and colleagues' empirical categorization of chronic pain patients on a new and larger sample. Moreover, this work aimed to extend previous knowledge by considering various treatment outcomes and exploratorily analyzing which coping skills might be particularly relevant for treatment success in each subtype., Materials and Methods: Latent class analysis was used to identify homogenous subtypes with different pain processing patterns using the pain processing questionnaire (FESV)., Results: By analyzing 602 inpatients with chronic primary pain, we identified 3 subtypes: (1) severely burdened individuals with low coping skills , (2) mildly burdened individuals with high coping skills , and (3) moderately burdened individuals with moderate coping skills. Pain interference, psychological distress, and cognitive and behavioral coping skills improved after treatment in all subtypes. Pain-related mental interference significantly improved only in subtypes (1) and (3). Only individuals of subtype (3) reported significant reductions in pain intensity after treatment. Exploratory regression analysis suggested that of subtype (1), the most promising targets in reducing pain interference and psychological distress posttreatment might be to foster relaxation techniques, counteractive activities, and cognitive restructuring . None of the FESV dimensions significantly predicted treatment outcomes among individuals of subtype (2). Individuals of subtype (3) might benefit the most from experiencing more competence during treatment., Discussion: Our findings highlight the importance of identifying and characterizing subtypes of chronic primary pain patients and that these subtypes should be considered for individualized and effective treatment., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Most patients suffering from chronic pain are more susceptible to pain and pressure due to higher pain sensitivity. Since psychosocial factors play a central role in developing and maintaining chronic pain, investigating associations between pain sensitivity and psychosocial stressors promises to advance the biopsychosocial understanding of chronic pain., Objectives: We aimed to replicate Studer et al.'s (2016) findings about associations of psychosocial stressors with pain sensitivity in a new sample of patients with chronic primary pain (ICD-11, MG30.0)., Methods: A pain provocation test was used on both middle fingers and earlobes to assess pain sensitivity among 460 inpatients with chronic primary pain. Potentially life-threatening accidents, war experiences, relationship problems, certified inability to work, and adverse childhood experiences were assessed as potential psychosocial stressors. Structural equation modeling was used to investigate associations between psychosocial stressors and pain sensitivity., Results: We partially replicated Studer et al.'s findings. Similar to the original study, patients with chronic primary pain showed enhanced pain sensitivity values. Within the investigated group, war experiences (β = 0.160, p < .001) and relationship problems (β = 0.096, p = .014) were associated with higher pain sensitivity. In addition, the control variables of age, sex, and pain intensity also showed a predictive value for higher pain sensitivity. Unlike Studer et al., we could not identify a certified inability to work as a predictor of higher pain sensitivity., Conclusions: This study showed that beyond age, sex, and pain intensity, the psychosocial stressors of war experiences and relationship problems were associated with higher pain sensitivity., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Given the increasing incidence and prevalence of chronic pain, effective treatments for chronic pain are needed. This study aimed to investigate the role of cognitive and behavioral pain coping regarding the prediction of treatment outcomes among inpatients with chronic primary pain participating in an interdisciplinary multimodal treatment program., Methods: At intake and discharge, 500 patients with chronic primary pain completed questionnaires on pain intensity, pain interference, psychological distress, and pain processing., Results: Patients' symptoms, cognitive and behavioral pain coping improved significantly after treatment. Similarly, separate cognitive and behaviroal coping skills improved significantly after treatment. Hierarchical linear models revealed no significant associations of pain coping with reductions in pain intensity. Whereas the overall level and improvements in cognitive pain coping predicted reductions in pain interference and psychological distress, the overall level and improvements in behavioral pain coping were associated with reductions in pain interference alone., Discussion: Since pain coping seems to influence both pain interference and psychological distress, improving cognitive and behavioral pain coping during an interdisciplinary multimodal pain treatment seems to be a key component in the successful treatment of inpatients with chronic primary pain, enabling them to function better physically and mentally despite their chronic pain. Clinically, it might be worth fostering and exercising cognitive restructuring as well as action planning in treatment to reduce both pain interference and psychological distress levels post-treatment. In addition, practicing relaxation techniques might help reduce pain interference post-treatment, whereas making experiences of personal competence might help reduce psychological distress post-treatment., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Recent recommendations for the treatment of chronic pain patients during the coronavirus disease 2019 (COVID-19) pandemic suggest using telemedicine instead of in-person consultations. Knowing whether patients with chronic pain are receptive to the use of telemedicine during a pandemic might improve tailored care., Objective: The aims of the present study were to assess patients' acceptance of telemedicine during the COVID-19 pandemic in Switzerland and to examine the correlation of acceptance with pain intensity and anxiousness., Methods: An anonymous survey was conducted from March 31, 2020, to July 30, 2020, with 61 patients referred to the Pain Center at the Bern University Hospital Inselspital in Bern, Switzerland. Collected data were analyzed descriptively, and correlations were calculated between acceptance of telemedicine and mean levels of current pain, psychological distress, and fear of COVID-19., Results: Our main finding was an average level of acceptance of telemedicine, with a mean of 6.25 on a scale from 0 (not at all) to 10 (completely), with substantial variability and range (SD = 3.56). The acceptance of telemedicine correlated negatively with current mean pain level (r = -0.44), worries (r = -0.42), and fear of COVID-19 (r = -0.4), as well as positively with the general condition (r = 0.46)., Conclusions: Using telemedicine for chronic pain treatment during the COVID-19 crisis was accepted to a sufficient degree by a considerable proportion of patients. However, the higher the mean levels of pain and anxiousness, the lower the acceptance, indicating that these severely burdened patients may suffer most from treatment restrictions. For this subgroup, telemedicine might not suffice and in-person visits should be considered., (© 2021 World Institute of Pain.)

Adopting the perspective of another person is an important aspect of social cognition and has been shown to depend on multisensory signals from one's own body. Recent work suggests that interoceptive signals not only contribute to own-body perception and self-consciousness, but also to empathy. Here we investigated if social cognition - in particular adopting the perspective of another person - can be altered by a systematic manipulation of interoceptive cues and further, if this effect depends on empathic ability. The own-body transformation task (OBT) - wherein participants are instructed to imagine taking the perspective and position of a virtual body presented on a computer screen - offers an effective way to measure reaction time differences linked to the mental effort of taking an other's perspective. Here, we adapted the OBT with the flashing of a silhouette surrounding the virtual body, either synchronously or asynchronously with the timing of participants' heartbeats. We evaluated the impact of this cardio-visual synchrony on reaction times and accuracy rates in the OBT. Empathy was assessed with the empathy quotient (EQ) questionnaire. Based on previous work using the cardio-visual paradigm, we predicted that synchronous (vs. asynchronous) cardio-visual stimulation would increase self-identification with the virtual body and facilitate participants' ability to adopt the virtual body's perspective, thereby enhancing performance on the task, particularly in participants with higher empathy scores. We report that participants with high empathy showed significantly better performance during the OBT task during synchronous versus asynchronous cardio-visual stimulation. Moreover, we found a significant positive correlation between empathic ability and the synchrony effect (the difference in reaction times between the asynchronous and synchronous conditions). We conclude that synchronous cardio-visual stimulation between the participant's body and a virtual body during an OBT task makes it easier to adopt the virtual body's perspective, presumably based on multisensory integration processes. However, this effect depended on empathic ability, suggesting that empathy, interoception and social perspective taking are inherently linked., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Heydrich, Walker, Blättler, Herbelin, Blanke and Aspell.)

Background: Previous research has shown an association between burnout and low emotional competence (EC), defined as the ability to adequately regulate the intensity and expression of emotions. EC might also play a maintaining role in depression. The current paper aimed at studying the effect of improved EC on the course of burnout and depression., Methods: 113 psychiatric inpatients completed a set of standardized self-report questionnaires at intake, discharge and three months after treatment, assessing EC, burnout, and depression. Multi-level analyses investigated the effect of improved EC on burnout and depression., Results: Improved EC including a better emotion regulation during treatment predicted favourable treatment outcomes regarding burnout and depression symptoms., Limitations: The present results should be considered in light of some methodological limitations. Most importantly, the patient sample consists of patients of one inpatient ward and is therefore not representative of all burnout patients., Conclusions: This study supports EC as a putative mechanism of change in the multimodal treatment of inpatients with a stress-related depressive disorder and burnout. Clinical and research consequences of the findings will be discussed., Competing Interests: Declaration of Competing Interest Gianandrea Pallich and Barabara Hochstrasser were employed at the Burnout ward of the Private Hospital Meiringen., (Copyright © 2020. Published by Elsevier B.V.)

Objective: This study aimed to analyze the associations among depressive and anxiety and pain symptoms in patients diagnosed with chronic pain., Materials and Methods: Four hundred fifty-four inpatients who were consecutively admitted in a multimodal 3-week treatment in a tertiary, psychosomatic university clinic completed 25 items from the Brief Pain Inventory and the Hospital Anxiety and Depression Scale at baseline and after treatment termination. Associations among symptoms were explored by network analyses using the graphical least absolute shrinkage and selection operator to estimate their partial correlations, whereas Extended Bayesian Information Criterion was used to select the best network solution for the data. We explored symptoms' centrality and expected influence within the network and the minimum spanning tree for the network., Results: Besides expected associations within depressive and anxiety and pain symptoms, the estimated network showed several local associations between depressive and pain interference symptoms. The lacks of being cheerful and of laughing are 2 of the depressive symptoms that showed the greatest associations with pain interference and a strong centrality within the network. Sleep problems were associated with both anxiety and depressive symptoms and pain intensity symptoms. Although at posttreatment most of the symptoms showed a significant decrease, the strength of the associations between the symptoms within the network was significantly higher than at baseline., Discussion: The results support focusing psychosocial interventions in chronic pain treatment not only on reducing pain, anxiety, and sleep symptoms but also on enhancing positive affect. Future research is needed to replicate these findings using repeated within-person measures designs.

Long-term consequences of aversive childhood experiences: effects on the incidence of psychiatric illnesses Abstract. Early childhood stress experiences through physical, psychological and sexual abuse as well as emotional or physical neglect often lead to permanent changes in the psychological well-being. Clinically, this is shown among other things in an increased incidence of various psychiatric disorders. This narrative survey aims to summarize the current status of existing studies on early childhood stress experiences and related psychiatric consequences. Scientific publications from the online libraries PubMed, PsycINFO and GoogleScholar served as the database. The search was conducted under the keywords Adversive Childhood Events (ACE), Adverse Childhood, Childhood Trauma, Psychiatric Disorders, Health Consequences as well as their German translations. The search resulted in 46 studies to be considered.

Aversive childhood stress and its implications für expert reports using the example of chronic pain Abstract. Insurance-medical questions regarding the consequences of severe aversive childhood stress arise in the context of psychiatric and psychosomatic expert reports. In psychiatric expert reports, the insurance-medical weighting of disorders of thinking, feeling and behaviour is in the foreground. In psychosomatic expert reports the assessment of limited performance with regard to functional body symptoms are considered to be most important. The majority of expert reports in the psychosomatic field concern people with chronic pain disorders. Pain disorders can develop insidiously over the years or be triggered by accidents. For expert reports of chronic pain conditions, guidelines have been developed by the corresponding specialist bodies in Switzerland. These have been available in German and French since 2019 (www.sappm.ch). The following overview focuses on expert reports of chronic pain disorders and is based on the Swiss guidelines mentioned above. The demanding nature of writing such expert reports is also recognized by specialists in other European countries.

Background: Internet-based cognitive behavioral treatment (iCBT-I) for insomnia comprising different sleep-related cognitive and behavioral interventional components has shown some promise. However, it is not known which components are necessary for a good treatment outcome., Method: People suffering from insomnia (N = 104) without any other comorbid psychiatric disorders were randomized (2:2:1) to two guided internet-based self-help interventions for insomnia [multi-component cognitive behavioral self-help intervention (MCT); sleep restriction intervention for insomnia (SRT)], and care as usual [CAU]. In all three conditions, additional care or treatment was allowed. The primary outcome was insomnia severity measured with the insomnia severity index (ISI) at eight weeks. Furthermore, the two active conditions were compared regarding sleep efficacy from daily diary data over the eight weeks, and other measures from the daily protocols. Secondary outcomes included sleep quality, depressive symptoms, dysfunctional beliefs, and quality of life at post-treatment (eight weeks) and follow-up (six months after randomization)., Results: Both conditions were more effective than CAU at post-treatment, with medium to large between-group effect sizes on the primary outcome (ISI; MCT: Cohen's d = -1.15; SRT: d = -0.68) and small to medium between-group effect sizes for secondary outcomes. Treatment gains were maintained at six-month follow-up. Active conditions did not differ from each other on all measures from pre to post, except for dysfunctional beliefs about sleep, and sleep protocol data throughout the intervention. Participants in MCT were significantly more satisfied with the intervention than participants in SRT., Conclusions: Results of the present study indicate that CAU + MCT and CAU + SRT are both effective compared to CAU. There were no statistical differences regarding efficacy between the two active conditions, but participants in MCT reported to be more satisfied with the intervention., (Copyright © 2019 Elsevier B.V. All rights reserved.)