Evaluation of group and individual change in a multidisciplinary pain management program.

OBJECTIVES: Systematic reviews have consistently shown that multidisciplinary interventions are more effective than waitlist and other unimodal active treatments for a range of chronic pain conditions. However, these group-based statistics fail to inform us whether these programs result in clinically meaningful improvement at the individual level. The current study examines group changes and individual responsiveness to a CBT-informed multidisciplinary chronic pain management program. METHODS: The analyses are based on data obtained from 263 outpatients. In addition to examining group-based treatment effects, we evaluated individual responsiveness to the program using 3 different criteria for assessing clinically important change. RESULTS: Statistically significant improvement was found for all measures at posttreatment, with effect sizes ranging from small to medium. Gains were largely maintained at follow-up. The results of the clinically important change analysis revealed that not everyone improved uniformly, and the magnitude of change varied across the 3 different methods. This variability in the extent of improvement prompted further analyses in an attempt to identify individual differences that could predict responsiveness to treatment. No differences were found between responders and nonresponders to treatment. DISCUSSION: The results of our study are consistent with previous research, and highlight the potential for multidisciplinary programs to improve the well-being of individuals with chronic pain. Clinically important change analyses underscore the variability that exists in chronic pain patients and allows for a more fine grained evaluation of individual responsiveness to treatment. Considering the strengths and limitations of each methodological approach for assessing clinically important change, guidelines are offered for future research and program development.

Factors impacting decisions to decline or adhere to antidepressant medication in perinatal women with mood and anxiety disorders.

PURPOSE: To identify specific quantitative and qualitative factors that govern the decision to adhere or decline antidepressant medication in antenatal women with moderate-to-severe mood and anxiety disorders. METHODS: Fifty women (30 adherers, 20 decliners) were recruited between 18 and 34 weeks gestation in a tertiary care clinic for perinatal mothers. They were prospectively monitored 4 weeks apart up to 1-month postpartum on the: Hamilton Anxiety Scale, Hamilton Depression Scale, Mood Disorders Insight Scale, Antidepressant Compliance Questionnaire, Penn State Worry Questionnaire, and NEO Personality Inventory. Qualitative interviews were conducted at baseline. Hierarchical linear modeling determined illness trajectories of the two groups. RESULTS: Significantly different course of illness was observed in adherers versus decliners. Adherers had healthier attitudes toward depression and compliance with medication (P < .005). Decliners had less illness insight (P < .001) and cited fear of fetal exposure, and thought medication was unwarranted. CONCLUSIONS: Pregnant women experienced significantly divergent illness trajectories depending on if they accepted antidepressant medication therapy for their illness. Risk perception, attitudes, and illness insight impacted decisions surrounding adherence and decline.

Spinal cord stimulation in pregnancy: a literature review.

OBJECTIVE: Currently, the use of spinal cord stimulation (SCS) therapy is not recommended in pregnancy because the effects of SCS on the pregnancy and developing fetus are unknown. However, many SCS recipients are women of childbearing age who may later become pregnant. The purpose of the present report is to review and summarize the existing literature on the use of SCS therapy during the prenatal period. METHODS: We first present the case of a 38-year-old woman from our center who became pregnant after receiving an SCS implantation. We then provide a synopsis of previous reports that were identified in a literature search. We highlight the key findings from these cases as they relate to the course of pregnancy, fetal development, labor and delivery management, fertility, and technical complications. RESULTS: In our literature review, we identified 12 cases of pregnancy in 8 women. To these we add the present case. CONCLUSIONS: Women of childbearing age who are candidates for SCS implantation should be tested for pregnancy prior to implantation surgery. They also should be informed about the limited state of our scientific knowledge regarding the impact of this technology on reproductive health. For patients already implanted with SCS, decisions about ongoing use in the event of pregnancy should be made on an individual basis after a careful consideration of potential risks and benefits.

Psychometric evaluation of the five-factor Modified Drinking Motives Questionnaire--Revised in undergraduates.

The psychometric properties of the Modified Drinking Motives Questionnaire--Revised (Modified DMQ-R) [Blackwell, E., & Conrod, P. J. (2003). A five-dimensional measure of drinking motives. Unpublished manuscript, Department of Psychology, University of British Columbia], based on a five-factor model of drinking motives with separate coping-anxiety and coping-depression factors, were evaluated in undergraduates. In Study 1, confirmatory factor analyses supported the correlated five-factor model in two samples of undergraduate drinkers (N=726 and N=603). Furthermore, the five-factor model fit the data better than a four-factor model conceptually equivalent to that of Cooper [Cooper, M. L. (1994). Motivations for alcohol use among adolescents: Development and validation of a four-factor model. Psychological Assessment, 6, 117-128] (i.e., with coping-anxiety and coping-depression items constrained to a single factor). In Study 1, drinking motives were predictive of concurrent drinking frequency and typical number of alcoholic beverages per occasion, over and above demographics. In Study 2, the Modified DMQ-R scores showed good to excellent test-retest reliability in a sample of undergraduates who were relatively frequent drinkers (N=169). Also, drinking motives prospectively predicted number of drinks consumed per week and alcohol-related problems, over and above demographics and initial alcohol use. Notably, coping-anxiety and coping-depression motives were distinctly related to alcohol consumption and alcohol problems.

Differentiating the impact of episodic and chronic stressors on hypothalamic-pituitary-adrenocortical axis regulation in young women.

OBJECTIVE: The goal of this study was to examine the impact of episodic stress and chronic interpersonal stress on indices of HPA regulation. To explore the potential downstream consequences of altered HPA dynamics, the authors also assessed indicators of metabolic control and systemic inflammation. DESIGN: One hundred four medically healthy women between the ages of 15 and 19 participated. Following an in-depth interview of life stress, a sample of blood was drawn through antecubital venipuncture. Over the course of the next 2 days, participants gathered salivary cortisol samples. MAIN OUTCOME MEASURES: Cortisol morning response, cortisol daily output, glucocorticoid receptor (GR) mRNA, C-reactive protein (CRP), insulin, and glucose. RESULTS: The simple presence of episodic stress or chronic interpersonal stress was not reliably associated with cortisol output, GR mRNA, insulin, or glucose. When women were exposed to an episodic stressor in the midst of chronic stress they showed increased cortisol output and reduced expression of GR mRNA. By contrast, when women had low levels of chronic stress, episodic events were associated with decreased cortisol output and increased GR mRNA. Episodic and chronic stress also interacted to predict CRP, but not insulin or glucose. CONCLUSIONS: The impact of episodic stress is accentuated in the midst of chronic interpersonal stress and diminished in its absence. Simultaneous exposure to episodic and chronic stress may create wear and tear on the body, whereas exposure to episodic stress in the context of a supportive environment may toughen the body, protecting it against subsequent stressors.

Applying mixed regression models to the analysis of repeated-measures data in psychosomatic medicine.

OBJECTIVE: Although repeated-measures designs are increasingly common in research on psychosomatic medicine, they are not well suited to the conventional statistical techniques that scientists often apply to them. The goal of this article is to introduce readers to mixed regression models, which provide a more flexible and accurate framework for managing repeated-measures data. METHODS AND RESULTS: We begin with a summary of the advantages that mixed regression models have over conventional statistical techniques in the context of repeated-measures designs. Next, we outline the conceptual and mathematical underpinnings of mixed regression models for a nonstatistical audience. The article ends with two examples of how these models can be applied in psychosomatic research; one deals with a prospective investigation of depressive symptoms and change in body mass index in older adults and the other with a diary study of social interactions and cortisol secretion. CONCLUSIONS: Mixed regression models offer a flexible and powerful approach to analyzing repeated-measures data. They possess important advantages over more traditional strategies, and more widespread application of these models is likely to enhance the overall quality of psychosomatic research.