Coping with depression and anxiety: preliminary results of a standardized course for elderly depressed women.

The experiences of 51 elderly depressed female patients with a standardized course "Coping with Depression and Anxiety" were investigated. Preliminary findings concerning the effectiveness of this course in 34 patients who completed the course will also be presented. This course consisted of psychoeducation and skills training. Depressive symptoms were scored by using the SCL-90 depression scale and the Geriatric Depression Scale. Results indicate that patients were very enthusiastic about the course and that there was no need to make major changes in its structure and content. Also, depressive symptoms were significantly reduced after completion of the course, which emphasizes the importance of this psychoeducational program in the treatment of depression in elderly female patients.

Responders and nonresponders to autogenic training and cognitive self-hypnosis: prediction of short- and long-term success in tension-type headache patients.

The present study was conducted to determine whether demographic variables, medical status variables, and psychological measures at pretreatment were related to pain reduction immediately following behavioral treatment for headache and at a 6-month follow-up. The study sample consisted of 156 subjects, who were selected for participation in a behavioral outcome study on the efficacy of autogenic training and cognitive self-hypnosis training. A Headache Index based on pain diaries constituted the main outcome measure. Psychological measures included the Symptom Checklist-90, Dutch Personality Questionnaire, Coping Strategy Questionnaire, Multidimensional Locus of Pain Control Questionnaire, and treatment expectations. Subjects who expected more pain reduction at pretreatment achieved a lower level of pain at posttreatment, independent of pretreatment pain levels. None of the other pretreatment variables were related with pain reduction at posttreatment or at the follow-up. Finally, at the 6-month follow-up, 43 subjects were classified as responders (more than 50% pain reduction) and 113 as nonresponders (less than 50% pain reduction and dropouts). At pretreatment, the responders perceived more pain control than the nonresponders. None of the other pretreatment differences between responders and nonresponders proved to be significant. The main conclusion that could be drawn from this study was that pain reduction, in the short- and long-term, cannot be predicted with any accuracy by demographic and medical status variables or scores for psychological distress, personality traits, coping strategy use, and pain appraisals.

Autogenic training and self-hypnosis in the control of tension headache.

This study compares autogenic training and training in multiple self-hypnosis strategies in a sample of 56 patients diagnosed as having chronic tension headache on the basis of medical evaluation by a neurologist. At posttreatment and follow-up, no differences between the two treatment regimens in the reduction of headache and psychological distress were observed. During treatment, patients reduced their headache activity and level of psychological distress significantly in contrast to the waiting-list period (p < 0.05). Follow-up measurements indicated that therapeutic improvement was maintained (p < 0.05). Short-term and long-term pain reduction was accompanied by an increase in perceived pain control (p < 0.003). Moreover, those patients who attributed the pain reduction obtained during therapy to their own efforts manifested long-term pain reduction (p < 0.003).

Hypnosis and autogenic training in the treatment of tension headaches: a two-phase constructive design study with follow-up.

Tension headaches can form a chronic (very long duration) condition. EMG biofeedback, relaxation training and analgesia by hypnotic suggestion can reduce the pain. So far, no differences have been demonstrated between the effects of various psychological treatments. In a constructively designed study, we firstly compared an abbreviated form of autogenic training to a form of hypnotherapy (future oriented hypnotic imagery) which was not presented as hypnosis and secondly we compared both treatments to the same future oriented hypnotic imagery, but this time explicitly presented as hypnosis. The three treatments were equally effective at post-treatment, but after a 6-month follow-up period, the future oriented hypnotic imagery which had been explicitly presented as hypnosis was superior to autogenic training. Contrary to common belief, it could be demonstrated that the therapists were as effective with the treatment modality they preferred as with the treatment modality they felt to be less remedial.

Biochemical measures in patients with a somatoform pain disorder, before, during, and after treatment with amitriptyline with or without flupentixol.

The possible relationship between a number of biochemical parameters and measures of pain and depression was studied in chronic pain patients without a major depression. In a double-blind crossover study, patients were treated with amitriptyline combined with a low dose of flupentixol or placebo. We investigated whether pretreatment biochemical values correlated with initial data on pain and/or depression, or whether they had predictive value for treatment outcome. We also studied systematically the effect of both treatment regimes on the biochemical parameters themselves and their relation to the plasma levels of amitriptyline. From our results, the possible involvement of the serotonin system in somatoform pain disorder is confirmed and no direct relation with the noradrenergic system could be inferred. The lack of involvement of a number of putative, depression-related, biochemical parameters suggests that affective disorders and pain syndromes do not share all mechanisms in common.

Multimodal treatment programmes for chronic pain: a quantitative analysis of existing research data.

This article reviews the empirical data obtained in existing studies on the multimodal treatment of chronic pain. The majority of these 'treatment packages' are based on a cognitive/behavioural perspective. The articles for review were selected from the scientific literature on this subject which has appeared since the first publication of Fordyce in 1973. The following aspects have been analysed: the goal and structure of the treatment programmes; the method of evaluating treatment results; and the indications for treatment. Programmes for in-patients and out-patients have been compared because it is very likely that there are differences between the treatment methods and study populations. The interval validity and clinical relevance of the available research are discussed in the conclusion.

Chronic pain beyond patienthood.

Forty nonconsumers (subjects with pain lasting for more than 1 year who had not consulted a doctor because of it during the preceding year) were compared with 46 chronic patients at a pain clinic. The mean duration of the nonconsumers' pain was twice as long as that of the patients'. Although their pain intensity, as assessed with pain diaries, did not differ, their estimated pain intensity was less than that of the pain patients; they took fewer analgesics, were less functionally impaired, made less use of coping strategies associated with poor adjustment, were less depressed, and expected less help from external resources. The "non-consumer attitude" appears to be independent of the duration of the pain complaints.

Does addition of low-dose flupentixol enhance the analgetic effects of low-dose amitriptyline in somatoform pain disorder?

In a double-blind, crossover study, the effects of 75 mg amitriptyline alone during 5 weeks on pain intensity were compared with the effects of a combination of 75 mg amitriptyline and 3 mg flupentixol during 5 weeks in 34 patients with somatoform pain disorder. Both treatments resulted in a statistically significant reduction in pain. However, pain reduction in the combined treatment did not differ from that in the treatment with amitriptyline as a single drug. Neither tardive dyskinesias nor other serious side effects were observed. The results do not support the clinical practice of adding low-dose neuroleptics to low-dose antidepressants in the treatment of somatoform pain disorder.

The relationship of personality variables and patient recruitment to pain coping strategies and psychological distress in tension headache patients.

The relationship of personality variables and patient recruitment to pain coping strategies and psychological distress was assessed in a Dutch sample of 111 chronic tension headache patients. Using the Coping Strategy Questionnaire (CSQ), high scores on the factor of helplessness proved to be associated with psychological distress. In particular, patients who manifested neuroticism and hostility as personality traits and who were referred for treatment by physicians achieved higher scores on the factor of helplessness. Patients who reported a lower level of pain intensity manifested a higher perceived control of pain. Patients who reported shorter daily pain periods indicated a lower level of active coping with pain. It is concluded that future research must be more attentive to the complex interactions between personality variables, environmental factors, and the coping demands posed by the nature of the pain problem.

Autogenic training and future oriented hypnotic imagery in the treatment of tension headache: outcome and process.

The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in the autogenic therapy condition and 27 in the future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version [van der Velden & Spinhoven, 1984] of the Creative Imagination Scale [Barber & Wilson, 1978/79; Wilson & Barber, 1978]). After statistically controlling for relaxation and imagery, hypnotizability scores (as assessed with the Dutch version [Oyen & Spinhoven, 1983] of the Stanford Hypnotic Clinical Scale [Morgan & J.R. Hilgard, 1975, 1978/79]) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo-dissociation and social-cognitive model of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed.

Low dose amitriptyline in chronic pain: the gain is modest.

In the double-blind placebo-controlled study presented here, the effects were investigated of a low dose of amitriptyline (75 mg) in patients with chronic pain of various origins. The active drug was superior to placebo in reducing pain intensity. The reduction was small. In the second treatment week, the amitriptyline treated patients slept longer. No differences between active drug and placebo were found with respect to daily activities or use of analgesics. Based on our data and those of other studies, it is concluded that amitriptyline (and other antidepressants) in low doses does have a positive effect on the intensity and some other aspects of chronic pain, but that the effect is modest. It must be kept in mind that chronic pain is a very treatment-resistant condition. Therefore, even modest positive effects may be worthwhile.

Education and self-hypnosis in the management of low back pain: a component analysis.

The aim of this study was to conduct a component analysis of a group programme for chronic low back pain patients. Forty-five patients participated in the pain control course, consisting of education about pain and a training in self-hypnosis. A pain diary was used as a measure of pain intensity, up-time and use of pain medication. Psychoneuroticism and depression were assessed using the Symptom Checklist-90 (SCL-90). No evidence was found for a differential efficacy of education or self-hypnosis on pain diary and SCL-90 scores. On completion of the total treatment package, patients manifested statistically significant changes on all measures except reported pain intensity. It is suggested that the pain control course is a non-invasive, inexpensive means of treatment which could be of some value in teaching even more severely disabled low back pain patients to cope more adequately with their pain problem. For this group of patients, a better adjustment to continuing pain may prove to be a more realistic therapy goal than pain reduction.

Analgesic and antidepressive effects of low-dose amitriptyline in relation to its metabolism in patients with chronic pain.

The analgesic and antidepressive effects of amitriptyline (AT) in relation to its kinetics and metabolism were studied in 19 outpatients with chronic pain who received a daily dose of 75 mg AT for at least 6 weeks. Riboflavin was added to the medication to check compliance. On days 0, 4, and 8 and weeks 3, 6, 9, and 12 after the start of dosing, blood samples were drawn from the patients 10 +/- 1 hours after the first morning dose and a sample of the first morning urine was taken to check riboflavin. Serum levels of AT and its metabolites, especially nortriptyline (NT) and E-10-hydroxy-nortriptyline (E-10-OH-NT), were measured by HPLC. On day 0 and at 3, 6, and 12 weeks the severity of depression was scored by means of a self-rating depression scale and pain intensity scores were measured. In addition, after 6 weeks of dosing patients estimated their percentage of pain in comparison with baseline. Mean (+/- SD) steady-state concentrations of AT, NT, and E-10-OH-NT were 36 +/- 23.5, 28 +/- 14.9, and 52 +/- 23.7 micrograms/L, respectively, in male patients (n = 8; age 45 +/- 7.4 years) and 34 +/- 14.6, 45 +/- 25.1, and 40 +/- 15.6 micrograms/L, respectively, in female patients (n = 11; age 46 +/- 6.8 years). There was a significant sex-related difference in the NT/AT ratio, which was higher in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient evaluation of a cognitive behavioral group program for patients with chronic low back pain.

Traditional approaches to curing patients with chronic benign pain have had only limited success. Rehabilitation becomes therefore more important and in recent years management programs have been developed to achieve this goal. This study was based on the hypothesis that a program can be more effective with its structure according to the comments of patients with respect to the various components of the program. After testing this hypothesis we conclude that such subjective evaluation of treatment is an important factor which merits receiving more attention than previous work has suggested.