Patient attitudes towards faecal sampling for gut microbiome studies and clinical care reveal positive engagement and room for improvement.

Faecal sample collection is crucial for gut microbiome research and its clinical applications. However, while patients and healthy volunteers are routinely asked to provide stool samples, their attitudes towards sampling remain largely unknown. Here, we investigate the attitudes of 780 Dutch patients, including participants in a large Inflammatory Bowel Disease (IBD) gut microbiome cohort and population controls, in order to identify barriers to sample collection and provide recommendations for gut microbiome researchers and clinicians. We sent questionnaires to 660 IBD patients and 112 patients with other disorders who had previously been approached to participate in gut microbiome studies. We also conducted 478 brief interviews with participants in our general population cohort who had collected stool samples. Statistical analysis of the data was performed using R. 97.4% of respondents reported that they had willingly participated in stool sample collection for gut microbiome research, and most respondents (82.9%) and interviewees (95.6%) indicated willingness to participate again, with their motivations for participating being mainly altruistic (57.0%). Responses indicated that storing stool samples in the home freezer for a prolonged time was the main barrier to participation (52.6%), but clear explanations of the sampling procedures and their purpose increased participant willingness to collect and freeze samples (P = 0.046, P = 0.003). To account for participant concerns, gut microbiome researchers establishing cohorts and clinicians trying new faecal tests should provide clear instructions, explain the rationale behind their protocol, consider providing a small freezer and inform patients about study outcomes. By assessing the attitudes, motives and barriers surrounding participation in faecal sample collection, we provide important information that will contribute to the success of gut microbiome research and its near-future clinical applications.

Mindfulness, acceptance and catastrophizing in chronic pain.

OBJECTIVES: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain. METHODS: A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center. RESULTS: The results show that general psychological acceptance (measured with the AAQ-II) is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS) did not predict levels of pain-related catastrophizing. DISCUSSION: Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of "acting with awareness" is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.

Chronic pain and severe disuse syndrome: long-term outcome of an inpatient multidisciplinary cognitive behavioural programme.

OBJECTIVE: Patients with chronic pain and severe disuse syndrome have pain with physiological, psychological and social adaptations. The duration and severity of complaints, combined with previously failed treatments, makes them unsuitable for treatment in primary care. DESIGN: A prospective waiting list controlled study. PATIENTS: A total of 32 patients with chronic pain for at least one year and severe disuse syndrome were included in an inpatient multidisciplinary cognitive behavioural treatment. METHODS: Patients were assessed before the waiting list period, before the clinical phase, after the clinical phase and after follow-ups of 6 months and one year. The visual analogue scale for pain and fatigue were assessed. Muscle strength of the arms and legs, arm endurance and a 6-minute walking test were used to assess physical outcome. The Symptom Checklist-90, RAND-36, pain cognition list and the Tampa scale for kinesiophobia were used to assess psychological outcome. RESULTS: Long-term significant (p < 0.001) improvements were found for pain, fatigue, walking distance, muscle strength, anxiety, depression, somatization, negative self-efficacy, and catastrophizing in the intervention period. CONCLUSION: An inpatient multidisciplinary cognitive behavioural programme is beneficial for patients with chronic pain and a severe disuse syndrome.

The relationship between psychosocial distress and disability assessed by the Symptom Checklist-90-Revised and Roland Morris Disability Questionnaire in patients with chronic low back pain.

BACKGROUND CONTEXT: In the assessment and treatment of chronic low back pain (CLBP) patients, the biopsychosocial model is used worldwide. Psychological distress has been reported to have a strong relationship with disability as measured with several instruments. The relationship between psychosocial distress measured with the Symptom Checklist-90-Revised (SCL-90-R) and self-reported disability measured with the Roland Morris Disability Questionnaire (RMDQ) has not been investigated. PURPOSE: To analyze the relationship between psychosocial distress measured with the SCL-90-R and self-reported disability measured with the RMDQ in patients with CLBP. STUDY DESIGN/SETTING: This cross sectional study was performed in an outpatient pain rehabilitation setting. PATIENT SAMPLE: The study sample consisted of 152 patients with CLBP. OUTCOME MEASURES: SCL-90-R and RMDQ. METHODS: All patients admitted for multidisciplinary treatment completed the SCL-90-R and RMDQ before treatment. Pearson's correlation coefficients between SCL-90-R (Global Severity Index and subscales) and RMDQ were calculated. RESULTS: Correlation coefficients between SCL-90-R (Global Severity Index and subscales) and RMDQ ranged from 0.18 to 0.31 (p<.05). CONCLUSION: The relationship between psychosocial distress measured with the SCL-90-R and self-reported disability measured with the RMDQ in CLBP patients is weak.

Patients' use of the Internet for pain-related medical information.

OBJECTIVE: Patients increasingly use the Internet for medical information. For doctor-patient communication it is important to gain insight into the use and impact of medical Internet searches of patients. This study aims to evaluate patients' use of the Internet for information about their pain problem. METHODS: A self-administered survey on pain-related Internet use was sent to 200 new patients attending a university pain center. The response rate was 61%. RESULTS: Half of all respondents used the Internet for medical information and a smaller percentage (39%) searched for specific information about pain. Patients found information on the Internet to be of good quality and quite easy to find and understand. In general, Respondents did not learn anything new. The on-line medical information confirmed what they already knew. Less than half of the respondents discussed information from the Internet with their physician. CONCLUSION: Half of all patients used the Internet for medical information. Patients are reasonably certain that the information is accurate and reliable, while this may not always be the case. PRACTICE IMPLICATIONS: Physicians should inquire about patients' use of various sources of information (such as the Internet) and offer to clarify any questions or concerns that arise from that use.

Personality: predictor of neurostimulation outcomes in patients with chest pain and normal coronary arteries.

Objectives. To study the impact of personality traits on the effect of neurostimulation in patients with chest pain and normal coronary arteries. Materials and Methods. Using the Dutch personality questionnaire, we retrospectively studied the personality traits in 33 patients treated with neurostimulation, either transcutaneous electrical nerve stimulation or spinal cord stimulation after 5 years. Neurostimulation was successful in 21 patients. Baseline characteristics and medication also were assessed for possible interactions with personality traits and neurostimulation outcome. Results. Patients with beneficial neurostimulation scored lower on the "social inadequacy" scale than patients with neurostimulation failure (p = 0.032). In univariate analyses, low scores at the "social inadequacy" scale and the use of calcium antagonists were associated with beneficial outcome of neurostimulation. In multivariate analysis low scores at the "social inadequacy" scale remained an independent predictor for beneficial neurostimulation outcome, when adjusted for other variables. Conclusion. Personality traits are a determining factor in the evaluation of neurostimulation for patients with chest pain and normal coronary arteries.