The effect of patient-practitioner communication on pain: a systematic review.

BACKGROUND AND OBJECTIVE: Communication between patients and health care practitioners is expected to benefit health outcomes. The objective of this review was to assess the effects of experimentally varied communication on clinical patients' pain. DATABASES AND DATA TREATMENT: We searched in July 2012, 11 databases supplemented with forward and backward searches for (quasi-) randomized controlled trials in which face-to-face communication was manipulated. We updated in June 2015 using the four most relevant databases (CINAHL, Cochrane Central, Psychinfo, PubMed). RESULTS: Fifty-one studies covering 5079 patients were included. The interventions were separated into three categories: cognitive care, emotional care, procedural preparation. In all but five studies the outcome concerned acute pain. We found that, in general, communication has a small effect on (acute) pain. The 19 cognitive care studies showed that a positive suggestion may reduce pain, whereas a negative suggestion may increase pain, but effects are small. The 14 emotional care studies showed no evidence of a direct effect on pain, although four studies showed a tendency for emotional care lowering patients' pain. Some of the 23 procedural preparation interventions showed a weak to moderate effect on lowering pain. CONCLUSIONS: Different types of communication have a significant but small effect on (acute) pain. Positive suggestions and informational preparation seem to lower patients' pain. Communication interventions show a large variety in quality, complexity and methodological rigour; they often used multiple components and it remains unclear what the effective elements of communication are. Future research is warranted to identify the effective components.

Self-cutting versus intentional overdose: psychological risk factors.

Individuals who present to emergency departments with self-harm are at elevated risk of further self-harm and suicide, and these risks are yet higher among patients who self-cut. Repetitive self-injury has previously been explained using a behaviourist approach focussing on operant conditioning, but we propose that the increased risk of self-harm repetition among those who present with self-cutting is at least partly mediated by pre-existing psychological risk factors. Several studies show that those who present with self-cutting differ from intentional overdose patients on demographic, psychiatric and social factors, but, based on findings from community-based studies, we hypothesise that there may be additional psychological differences that may also be associated with increased repetition risk. We conducted a small-scale cohort study of 29 self-harm patients presenting to A&E and compared theoretically-derived psychological variables between 8 self-cutting and 21 overdose patients. Those presenting with self-cutting scored significantly higher on hopelessness and lower on non-reactivity to inner experience and generally had a more vulnerable profile than those presenting with overdose. These findings support our hypothesis that the association between self-cutting and prospective repetition is at least partly due to pre-existing psychological vulnerabilities that increase both the likelihood of engaging in self-cutting as a method of self-harm and the likelihood of subsequent repetition of self-harm. Existing evidence suggests that self-cutting is a risk factor for repetition of self-harm, and it is possible that reducing and preventing repetition among these patients can be achieved by implementing psychological interventions to reduce hopelessness and increase tolerance of emotional distress.

Experiences of sleep paralysis in a sample of Irish university students.

BACKGROUND: Sleep paralysis (SP) is characterised by an inability to move voluntarily for a period on going to sleep or on waking. It is also associated with hallucinations, and often with fear. This study seeks to explore the experience of SP in an Irish university sample. METHODS: A cross-sectional survey design was employed, with a validated scale for the assessment of SP being distributed to 2,500 students. A total of 418 responded, of whom 83 reported having experienced SP. RESULTS: The most commonly reported and most intense hallucinations were falling, sensed presence, visual hallucination, pressure on the body and belief might be dying. Fear was also commonly experienced. Bivariate analyses showed an association between fear and several hallucination types. CONCLUSION: SP in university students often includes experience of hallucinations. These, in turn, are associated with frequent and intense fear.

Sharing and borrowing prescription medication: a survey of Irish college students.

BACKGROUND: Prescription medicine borrowing and sharing has received not much attention in the research literature, despite serious potential health risks. Although this behaviour is prevalent across all ages, it appears to be particularly high amongst young adults. AIMS: To determine the prevalence and the characteristics of sharing and borrowing medicines amongst students in an Irish University. METHOD: Web survey of University College Cork 18-25-year-old undergraduates. RESULTS: A total of 343 completed the questionnaire. A quarter (26%) reported borrowing, 20% reported sharing and 12% reported both sharing and borrowing prescription drugs, primarily to avoid the cost (37%), the inconvenience of going to a doctor (22%) and not feeling sick enough to see a medical professional (14%). Participants borrowed medicines from family (51.2%) and friends (18.2%). Those who borrowed or shared prescription drugs believed they were at a lesser risk of side effects from taking other people's medicines (p < 0.0005, χ(2) test). CONCLUSION: Sharing and borrowing prescription drugs appear to be a common practice amongst Irish college students, who may underestimate the risks associated with taking these medicines.

Influence of context effects on health outcomes: a systematic review.

BACKGROUND: Throughout history, doctor-patient relationships have been acknowledged as having an important therapeutic effect, irrespective of any prescribed drug or treatment. We did a systematic review to determine whether there was any empirical evidence to support this theory. METHODS: A comprehensive search strategy was developed to include 11 medical, psychological, and sociological electronic databases. The quality of eligible trials was objectively assessed by two reviewers, and the type of non-treatment care given in each trial was categorised as cognitive or emotional. Cognitive care aims to influence patients' expectations about the illness or the treatment, whereas emotional care refers to the style of the consultation (eg, warm, empathic), and aims to reduce negative feelings such as anxiety and fear. FINDINGS: We identified 25 eligible randomised controlled trials. 19 examined the effects of influencing patients' expectations about treatment, half of which found significant effects. None of the studies examined the effects of emotional care alone, but four trials assessed a combination of both cognitive and emotional care. Three of these studies showed that enhancing patients' expectations through positive information about the treatment or the illness, while providing support or reassurance, significantly influenced health outcomes. INTERPRETATION: There is much inconsistency regarding emotional and cognitive care, although one relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance.