The patient-physician relationship and medical utilization.

OBJECTIVE: The goal of this study was to (1) explore the relationship between medical utilization and characteristics of the patient-physician relationship and (2) evaluate the relationship between physician perception of patient difficulty, chronic medical problems, and patient somatizing tendencies. METHOD: Patients in an academic family practice center were asked to complete a demographic data sheet, the PRIME-MD Patient Questionnaire, and the Barrett-Lennard Relationship Inventory regarding their relationship with their physicians. Their physicians completed the Difficult Doctor-Patient Relationship Questionnaire. Patient charts were examined for number of office visits and phone calls in the previous year, as well as number of chronic problems and medications. The study was conducted from September 2000 to November 2001. RESULTS: Forms were completed by 165 patients and 20 physicians. Forty-three patients who were approached refused to participate. Patient ratings on the Barrett-Lennard Relationship Inventory were not related to utilization measures. Physician ratings of difficulty were significantly related to phone calls and visits (p < .05), as well as PRIME-MD Patient Questionnaire somatization tendencies (p < .05) but not to number of chronic problems. Patient and physician ratings were not significantly correlated. Gender (p < .001), marital status (p < .04), education (p < .03), and employment status (p < .002) were all related to utilization measures. CONCLUSION: Medical utilization was associated with somatizing tendencies of patients and the physicians' perception of patient difficulty. Physicians rated patients as difficult if they tended to somatize but not if they had a number of chronic problems.

Biofeedback-assisted relaxation therapy in neurocardiogenic syncope: a pilot study.

This controlled pilot study explored the effects of biofeedback assisted relaxation (BFRT) in neurocardiogenic syncope. Twenty-two patients who completed a 2-week pretest, were randomized to either treatment or wait list control, followed by a 2-week posttreatment/control period. Treatment comprised electromyograph and thermal biofeedback, autogenic and progressive relaxation, and symptom-specific recommendations. Significant differences (p < .05) between groups were observed in the headache index and loss of consciousness, favoring the BFRT group. Both groups decreased state anxiety and depression. The Millon Behavioral Health Inventory was used to assess patients' coping style and adjustment to illness. The majority of the adult participants evidenced illness overreaction, preoccupation with illness, depressive feelings, and tendencies to nonadherence to therapy. BFRT is of potential benefit to patients with neurocardiogenic syncope, but further study is necessary to define the influence of coping style on outcome.

Biofeedback-assisted relaxation in migraine headache: relationship to cerebral blood flow velocity in the middle cerebral artery.

OBJECTIVE: To determine if migraineurs with aura respond differently to biofeedback/relaxation than those without aura and, if so, whether the variability in outcome can be explained by blood flow velocity. Background.-The relationship between cerebral blood flow velocity and treatment response to biofeedback/relaxation in migraine with and without aura is uncertain. METHOD: Twenty migraineurs underwent 12 sessions of biofeedback/relaxation therapy, while 20 controls simply were told to relax on their own. Cerebral blood flow velocity was measured bilaterally in the middle cerebral artery with transcranial Doppler. RESULTS: The biofeedback group showed significant (P <.05) reductions in pain, depression, and anxiety compared to the control group. Patients with and without aura did equally well. There were significant (P <.05) left to right blood flow velocity differences only in the migraine with aura group. Maximum blood flow velocities were significantly higher (P <.05) in the migraine with aura group than in the cohort without aura. There was an inverse correlation between indicators of anxiety and blood flow velocity, perhaps related to hyperventilation-induced constriction in the small vessels distal to the middle cerebral artery. CONCLUSION: The positive treatment response to biofeedback/relaxation in migraine headache is not related to presence of aura, nor to changes in blood flow velocity, but may be associated with reduction in anxiety and depression.

Psychophysiologic Therapy for Chronic Headache in Primary Care.

BACKGROUND: Headaches account for a high percentage of office visits to primary care physicians, with migraine and tension-type headaches the most common. This article provides a summary of psychophysiologic therapies for migraine and tension-type headache and considers psychosocial factors relevant to headache. Psychophysiologic therapy of headache consists primarily of relaxation and biofeedback. METHOD: Representative controlled studies, meta-analysis, and reviews are utilized to assess the efficacy of biofeedback and relaxation for migraine and tension-type headache. RESULTS: Psychophysiologic therapy comprising biofeedback and relaxation can be provided in standard or limited therapist contact formulas to patients as sole therapy or concurrently with medical therapy. Effectiveness has been demonstrated for thermal biofeedback-and electromyograph biofeedback-assisted relaxation with minimal or no side effects. A typical treatment protocol is offered to exemplify the integration of psychophysiologic therapy into primary care practice. CONCLUSION: Psychophysiologic therapy represents an important adjunctive treatment for chronic benign headache that can be incorporated into primary care.