Similarities and Differences in Interoceptive Bodily Awareness Between US-American and Japanese Cultures: A Focus-Group Study in Bicultural Japanese-Americans.

Interoceptive awareness is the conscious perception of sensations that create a sense of the physiological condition of the body. A validation study for the Japanese translation of the Multidimensional Assessment of Interoceptive Awareness (MAIA) surprised with a factor structure different from the original English-language version by eliminating two of eight scales. This prompted an exploration of the similarities and differences in interoceptive bodily awareness between Japanese and European Americans. Bicultural Japanese-Americans discussed concepts and experiences in the two cultures. We conducted focus groups and qualitative thematic analyses of transcribed recordings. 16 participants illustrated cross-cultural differences in interoceptive bodily awareness: switching between languages changes embodied experience; external versus internal attention focus; social expectations and body sensations; emphasis on form versus self-awareness; personal space; and mind-body relationship; context dependency of bodily awareness and self-construal. The participants explained key concepts that present challenges for a Japanese cultural adaptation of the MAIA, specifically the concept of self-regulation lost in the factor analysis. In Japanese culture, self-regulation serves the purpose of conforming to social expectations, rather than achieving an individual self-comforting sense of homeostasis. Our findings will inform the next phase of improving the MAIA's cross-cultural adaptation.

Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?

BACKGROUND: The 9-item STarT-Back screening tool was developed in primary care patients with low back pain (LBP) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well-defined acute LBP. METHODS: In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9-item STarT-Back. Participants were followed up at 6 months and 2 years. STarT-Back rules were applied to classify participant's risk of chronic LBP, and the performance of the screening items in predicting outcomes was assessed using likelihood ratios. RESULTS: The proportion of patients with chronic pain at follow-up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT-Back validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high-risk designation by items similar to the STarT-Back increased the pre-test probability to 31% and 35%. Likelihood ratios were close to 1. CONCLUSIONS: A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT-Back in patients with acute LBP and a need to consider a modification of its cut-offs.

The experience of breath as a therapeutic intervention - psychosomatic forms of breath therapy. A descriptive study about the actual situation of breath therapy in Germany, its relation to medicine, and its application in patients with back pain.

CONTEXT: Breath is a central element both in Eastern spiritual practice and in breath therapy, a treatment developed in Germany over the last 90 years. Among physicians, little is known about the working methods, goals, basic concepts, providers, and benefits for specific medical diagnoses of breath therapy. OBJECTIVE: To investigate the actual circumstances of breath therapy in Germany, its relation to medicine, and its application in patients with specific diagnoses. DESIGN: Descriptive study. SETTING: Germany. STUDY SUBJECTS: Members of the national association of breath therapists. INSTRUMENT: Questionnaire developed at Berlin Free University Medical Center in collaboration with the national association of breath therapists. OUTCOME MEASURES: Degree of approval/disapproval to given answers to semi-closed questions. RESULTS: Breath therapy, as practiced in Germany, is a therapeutic method distinct from somatic therapy and psychotherapy. It is primarily applied by nonmedical therapists in a private practice setting. Through the experience of physical sensations from the nonmanipulated breath rhythm, this method provides a physically grounded, deep personal experience of an integrated sense of self. Breath therapy appears to be particularly helpful in patients with chronic back pain. CONCLUSIONS: Results suggest that breath therapy brings about its therapeutic effect through enhanced proprioception which, as other studies have shown, is deficient in patients with chronic back pain. This first descriptive study on breath therapy is limited by the use of self-reports from therapists which cannot control for provider bias. This therapeutic intervention deserves further investigation and controlled clinical research.