Conceptualisations of pain amongst resettled Nepali-speaking Bhutanese adults in rural and regional Australia.

INTRODUCTION: Nepali-speaking Bhutanese refugees have been subject to one of the largest resettlement programs in the world and experience higher rates of chronic pain when compared to the general population. The purpose of this study was to explore qualitative conceptualisations of chronic pain among a group of Nepali-speaking Bhutanese adults with a refugee background who relocated to rural and regional Australia. METHODS: Participants included 22 individuals (females n=15) with chronic pain, who took part in structured qualitative focus groups exploring their experiences of chronic pain. Data were analysed using thematic analysis and five main themes were developed. RESULTS: The themes were: (1) pain is persistent and creates suffering, (2) pain is subjective and poorly understood, (3) pain is a biomedical problem that needs to be solved, (4) pain is complex and more than a biomedical problem, and (5) coping with pain is multi-faceted.Some participants viewed pain through a predominantly biomedical lens, and some recognised social and psychological factors as contributors to pain. Overwhelmingly, the participants believed pain is complex and multifaceted, requiring active and passive strategies for management, some of which are culturally informed. CONCLUSION: The experiences of resettled Nepali-speaking Bhutanese refugees living with pain are important to elucidate to improve healthcare inequalities among this marginalised group. This research will inform future assessment guidelines and treatment programs for Nepali-speaking Bhutanese adults living with chronic pain.

Stress in caregivers of individuals with intellectual or developmental disabilities: A systematic review of mindfulness-based interventions.

BACKGROUND: The efficacy of mindfulness-based interventions (MBIs) for stress and psychological distress in professional caregivers supporting individuals with intellectual or developmental disabilities (IDDs) is reviewed. METHODS: Eight studies met inclusion criteria and were systematically reviewed, including RCTs and single-group designs. RESULTS: As per Reichow, Volkmar, and Cicchetti (Journal of Autism and Developmental Disorders, 38, 2008), three studies were classified as "adequate quality" and five were classified as "weak." There were inconsistent findings in relation to stress, with significant reductions or increases reported by caregivers following MBIs. MBIs consistently improved caregivers' ratings of distress. Process outcomes suggested increased mindful awareness, increased cognitive defusion and reduced thought suppression. Treatment effects were maintained or continued to grow at follow-up. CONCLUSIONS: Caregivers of individuals with IDDs face multiple challenges on a daily basis. This review supports, at least, short-term benefits for MBIs in the management of stress and distress in caregivers of individuals with IDDs.

Delayed P100-Like Latencies in Multiple Sclerosis: A Preliminary Investigation Using Visual Evoked Spread Spectrum Analysis.

Conduction along the optic nerve is often slowed in multiple sclerosis (MS). This is typically assessed by measuring the latency of the P100 component of the Visual Evoked Potential (VEP) using electroencephalography. The Visual Evoked Spread Spectrum Analysis (VESPA) method, which involves modulating the contrast of a continuous visual stimulus over time, can produce a visually evoked response analogous to the P100 but with a higher signal-to-noise ratio and potentially higher sensitivity to individual differences in comparison to the VEP. The main objective of the study was to conduct a preliminary investigation into the utility of the VESPA method for probing and monitoring visual dysfunction in multiple sclerosis. The latencies and amplitudes of the P100-like VESPA component were compared between healthy controls and multiple sclerosis patients, and multiple sclerosis subgroups. The P100-like VESPA component activations were examined at baseline and over a 3-year period. The study included 43 multiple sclerosis patients (23 relapsing-remitting MS, 20 secondary-progressive MS) and 42 healthy controls who completed the VESPA at baseline. The follow-up sessions were conducted 12 months after baseline with 24 MS patients (15 relapsing-remitting MS, 9 secondary-progressive MS) and 23 controls, and again at 24 months post-baseline with 19 MS patients (13 relapsing-remitting MS, 6 secondary-progressive MS) and 14 controls. The results showed P100-like VESPA latencies to be delayed in multiple sclerosis compared to healthy controls over the 24-month period. Secondary-progressive MS patients had most pronounced delay in P100-like VESPA latency relative to relapsing-remitting MS and controls. There were no longitudinal P100-like VESPA response differences. These findings suggest that the VESPA method is a reproducible electrophysiological method that may have potential utility in the assessment of visual dysfunction in multiple sclerosis.

Symptom overlap in anxiety and multiple sclerosis.

BACKGROUND: The validity of self-rated anxiety inventories in people with multiple sclerosis (pwMS) is unclear. However, the appropriateness of self-reported depression scales has been widely examined. Given somatic symptom overlap between depression and MS, research emphasises caution when using such scales. OBJECTIVE: This study evaluates symptom overlap between anxiety and MS in a group of 33 individuals with MS, using the Beck Anxiety Inventory (BAI). METHODS: Participants underwent a neurological examination and completed the BAI. RESULTS: A novel procedure using hierarchical cluster analysis revealed three distinct symptom clusters. Cluster one ('wobbliness' and 'unsteady') grouped separately from all other BAI items. These symptoms are well-recognised MS-related symptoms and we question whether their endorsement in pwMS can be considered to reflect anxiety. A modified 19-item BAI (mBAI) was created which excludes cluster one items. This removal reduced the number of MS participants considered 'anxious' by 21.21% (low threshold) and altered the level of anxiety severity for a further 27.27%. CONCLUSION: Based on these data, it is suggested that, as with depression measures, researchers and clinicians should exercise caution when using brief screening measures for anxiety in pwMS.

Only low frequency event-related EEG activity is compromised in multiple sclerosis: insights from an independent component clustering analysis.

Cognitive impairment (CI), often examined with neuropsychological tests such as the Paced Auditory Serial Addition Test (PASAT), affects approximately 65% of multiple sclerosis (MS) patients. The P3b event-related potential (ERP), evoked when an infrequent target stimulus is presented, indexes cognitive function and is typically compared across subjects' scalp electroencephalography (EEG) data. However, the clustering of independent components (ICs) is superior to scalp-based EEG methods because it can accommodate the spatiotemporal overlap inherent in scalp EEG data. Event-related spectral perturbations (ERSPs; event-related mean power spectral changes) and inter-trial coherence (ITCs; event-related consistency of spectral phase) reveal a more comprehensive overview of EEG activity. Ninety-five subjects (56 MS patients, 39 controls) completed visual and auditory two-stimulus P3b event-related potential tasks and the PASAT. MS patients were also divided into CI and non-CI groups (n = 18 in each) based on PASAT scores. Data were recorded from 128-scalp EEG channels and 4 IC clusters in the visual, and 5 IC clusters in the auditory, modality were identified. In general, MS patients had significantly reduced ERSP theta power versus controls, and a similar pattern was observed for CI vs. non-CI MS patients. The ITC measures were also significantly different in the theta band for some clusters. The finding that MS patients had reduced P3b task-related theta power in both modalities is a reflection of compromised connectivity, likely due to demyelination, that may have disrupted early processes essential to P3b generation, such as orientating and signal detection. However, for posterior sources, MS patients had a greater decrease in alpha power, normally associated with enhanced cognitive function, which may reflect a compensatory mechanism in response to the compromised early cognitive processing.