Annotated Bibliography

Meta-analysis of psychological interventions for chronic back pain

Robert Kerns, Benson Hoffman

Health Psychology, 2007. Vol. 26 (1),1-9

Abstract

Summary

A number of studies have already underlined the fundamental psychological role in chronic pain. Robert Kerns, professor of psychiatry at Yale University, published a 2007 meta-analysis of 22 trials of psychological treatment for patients with chronic lower back pain. The results were that patients who learnt different methods of thinking about their pain (such as cognitive behavioural therapy or forms of meditation) could make that pain go away. Co-author of the report Benson Hoffman summed up the remarkable findings “These psychological treatments reduced the pain more than anything else.” (Source)

About the Authors

Robert Kerns, PhD is a Professor of Psychiatry, Neurology, and Psychology at Yale University. He received his BA in 1974 from West Virginia University and his MA and PhD from Southern Illinois University at Carbondale in 1980. His research is broadly in the area of behavioral medicine with specific interests in fields of pain and pain management. Dr. Kerns is Principal Investigator of the Pain Research, Informatics, Medical comorbidities, and Education (PRIME) Center funded by the Department of Veterans Affair that emphasizes the conduct of pain-relevant health services research that can inform policy, practice, and educational initiatives. (Source)

Benson M. Hoffman, PhD, is clinical associate and SMILE Study coordinator, department of psychiatry and behavioral sciences, Duke University Medical Center. In 2007 he did an interview with the American Pain Society in which he discusses the media attention TMS is receiving, as well as future TMS research. (Source)

Back pain, a communicable disease?

Heiner Raspe, Angelika Hueppe, Hannelore Neuhauser

International Journal of Epidemiology, 2008.

Abstract

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Summary

Western Europe has seen a recent rise in people reporting chronic back pain. It is estimated that up to 40% of adults in Western Europe have chronic back pain. This article seeks to show that back pain is a communicable disease. By looking at five German health surveys the study found a wide gap in back pain affictions between East and West Germany early after re-unification. This gap quickly closed and by 2003 the gap was near 0. The study's hypothesis was corroborated by experimental research showing that BP-related beliefs, attitudes and behaviour could positively be influenced by media campaigns and by insights from another recent epidemic. (Source)

A longitudinal, prospective study of industrial back injury reporting

Bigos SJ et al.

Clinical Orthopaedics and Related Research. 1992 Jun;(279):21-34.

Abstract

Summary

The authors prospectively evaluated 3020 volunteers of the Boeing-Everett plant to assess risk factors that predispose workers to file industrial back injury claims. During four years of follow-up observation, more than 279 subjects reported acute back problems. The effect of the only predictive physical variable was explainable by a history of medical treatment. The most predictive individual factors were (1) job task dissatisfaction and (2) distress as reported on Scale 3 of the Minnesota Multiphasic Personality Inventory (MMPI). This data perhaps explains why the focus on purely physical and injury-related factors has met with little success in dealing with what has become the most expensive orthopaedic problem. Clinically, nonphysical factors that significantly impact the reporting of back injuries may also affect patients' responses to medical treatment. (Source)

Childhood psychological trauma correlates with unsuccessful lumbar spine surgery

Schofferman J et al.

Spine 1992 Jun; Vol. 17(6 Suppl):S138-44

Abstract

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Summary

In a retrospective study of 86 patients who underwent lumbar spine surgery, patients who had three or more of a possible five serious childhood psychological traumas (risk factors) had an 85% likelihood of an unsuccessful surgical outcome. Conversely, in patients with a poor surgical outcome, the incidence of these traumas was 75%. In the group of 19 patients with no risk factors, there was only a 5% incidence of failure. This study shows that a highly significant correlation exists between unsuccessful lumbar spine surgery and a history of childhood traumas. Although recognition of predictors for unsuccessful outcome can be useful in avoiding surgery in patients whose indications for surgery are borderline, the greater challenge is to help the patient who, despite being at high psychological risk for negative outcome, has severe spinal pathology that will likely require surgery. In such cases, psychiatric treatment is critical. In the group of 19 patients with no risk factors, single-level laminectomies and discectomies were performed on 6 patients. The other 13 cases were complex, involving a combination of repeat surgeries (n = 4) fusions (n = 3), and/or multilevel laminectomies and discectomies (n = 11). (source)

Outcomes of a Mind-Body Treatment Program for Chronic Back Pain with No Distinct Structural Pathology-A Case Series of Patients Diagnosed and Treated as Tension Myositis Syndrome

David Schechter, AP Smith, J Beck, J Roach, R Karim, S Azen

Alternative Therapies in Health and Medicine. 2007. Vol. 13 (5): 26–35

Abstract

Other Articles by Author

Summary

There are several physicians that have argued for a shift in treatment protocol of chronic back pain. In four of his books and several journal publications Dr. John Sarno, of the New Yorks University's Rusk Institute of Rehabilitation, has argued for such a change. The primary objective of this study is to see if mind-body treatment warrants additional and more extensive research. The study was conducted in a physicians office in the Los Angeles area and included 51 patients who reported chronic back pain. Through a series of TMS related treatments a majority of the subjects reported their chronic back pain had decreased. This study suggests the value TMS treatment has on diminishing chronic back pain, and suggests more extensive research on TMS and the mind-body approach.

General Mindbody Research

Psychosomatic Concepts in Chronic Pain

Rashbaum Ira, Sarno John

Archives of Physical Medicine and Rehabilitation. 2003. Volume 84, Supplement 1 Pages S76-S80. Abstract

Summary

There are a wide range of obstacles and issues that make treating chronic pain difficult for physicians. One of the major problems tends to be the occasional lack of correlation between a patient's chronic pain and the test results. This study reviews these problems and investigates if there is a more effective and less expensive way to treat chronic back pain. The study includes an exploration into the effectiveness of the mind-body approach, along with TMS therapy, at treating chronic pain. This study is led by two of the most influential TMS practitioners and explores TMS treatments to standardized medical treatment for chronic pain. (Source)

About the Authors

Ira Rashbaum, MD is the Chief of Stroke Rehabilitation at Rusk. Rusk's Stroke Rehabilitation Program is one of the only programs nationwide to have received the CARF designation. The Program is recognized as one of the nation's leaders in stroke rehabilitation. Dr. Rashbaum cares for adult stroke inpatients and outpatients. He also cares for adults with general outpatient rehabilitation needs including chronic pain, cardiopulmonary rehabilitation and musculoskeletal disorders. (Source)

John Sarno, MD is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center. He graduated from The Columbia University College of Physicians and Surgeons in 1950. In 1965 he became the Director of the Outpatient Department at the Rusk Institute. He is also the originator of the diagnosis of the controversial psychosomatic condition, tension myositis syndrome (TMS). (Source)

Psychodermatology: The Mind and Skin Connection

J Koo, A Lebwohl

American Family Physician, 2001. Vol. 64:1873-1878.

Abstract

Full Text

Summary

There is a condition that involves a relation between the mind and the skin known as psychodermatologic disorders. There are three categories for these disorders: psychophysiologic disorders, primary psychiatric disorders, and secondary psychiatric disorders. The primary cause of these skin disorders is stress, low self-esteem, depression, and social phobia. This article investigates these disorders and their treatments, including using anxiety-decreasing techniques. This correlates with the mind-body approach of TMS because the study suggests that the cause of the skin disorder is not physical, rather it is psychological. (Source)

About the Authors

John Koo, M.D. is director of the Psoriasis and Skin Treatment Center and Phototherapy Unit and associate clinical professor and vice chairman for the department of dermatology at the University of California, San Francisco, Medical Center. He earned his medical degree from Harvard Medical School, Boston, and served a residency in psychiatry at the University of California, Los Angeles, Neuropsychiatric Institute, and a residency in dermatology at UCSF. University of California, San Francisco, Medical Center, San Francisco, California. (Source)

Andrew Lebwohl is a research assistant at the University of California, San Francisco, School of Medicine. University of California, San Francisco, School of Medicine, San Francisco, California. (Source)

The Powerful Placebo and the Wizard of Oz

JC Bailer

New England Journal of Medicine, 2001. Vol. 344:1630-1632.

Summary

A placebo should not be used therapeutically except perhaps for treating pain. A study published in 2001 showed that placebos were basically worthless for treating any other condition. (Source)

About the Author:

John C. Bailar III, a University of Chicago professor emeritus who chaired a 2003 National Academies committee that recommended major changes in the U.S. food safety system. (Source)

Somatoform Disorders: Severe Psychiatric Illnesses Neglected by Psychiatrists

Christopher Bass, Robert Peveler, Allen House

British Journal of Psychiatry. 2008 Vol. 179, 11-14

Abstract

Summary

This article investigates the growing number of patients who are referred to physicians and surgeons with chronic physical pain which can not be explained using standard medical practices. The article discusses why psychiatrists train without any experience of Somatoform Disorders, and why psychiatry neglects them. The study found that growth in psychiatric services has been hampered because health planners have compared severity with diagnosis instead of disability and level of need. The solution offered for higher Somatoform Disorders practiced is for more extensive research and higher quality of training, along with more active public awareness campaign. In relation to TMS, this article shows how chronic pain treatment is mistreated by a large majority of the medical establishment. Further, the study can shows that in order to incorporate TMS treatments into standardized medical protocol, there needs to be more extensive research and a high quality of training available to practitioners. Also, the study shows the need for more psychiatric involvement in Somatoform Disorders and TMS (Source)

About the Authors

Christopher Bass works for the Department of Psychiatric Medicine at John Radcliffe Hospital in Oxford

Robert Peveler is Professor of Psychiatry at the University and Honorary Consultant in Liaison Psychiatry. He trained in psychiatry and medicine in Oxford. Robert‘s interests include management of common mental health problems in primary care and general hospitals, and management of chronic pain and fatigue. He is currently working with the trust to establish new services for patients with chronic fatigue. Robert lives in Southampton, and is married with two children. (Source)

Allen House is the Director of LIHS and Liaison of Psychiatry at the University of Leeds. Allan has worked in Leeds since 1989. He has held his current post as Director of Leeds Institute of Health Sciences since 2006 and his chair in Liaison Psychiatry since October 1999. His current research interests involve: Psychiatric co-morbidity in physical disease, especially stroke and cancer; Self harm and suicide; and Medically unexplained physical syndromes. (Source)

Emotion and Pain Research

Why rejection hurts: a common neural alarm system for physical and social pain

Naomi I. Eisenberger and Matthew D. Lieberman

Trends in Cognitive Sciences. July 2004. Vol.8 No.7

Abstract

Summary

In this paper the authors demonstrate that the pathways in the brain that are activated by emotional distress (in this case, a game where the person is excluded; i.e. social exclusion) are the same pathways that are activated by physical pain. (Source)

About the Authors

Naomi Eisenberger graduated from UCLA with a B.S. in Psychobiology and then received a Ph.D. in Social Psychology from UCLA in 2005. She is currently a postdoctoral scholar at the UCLA Cousins Center for Psychoneuroimmunology investigating the influence of immune system activity on neural function. Her primary interests are in understanding how the need for social connection has left its mark on the mind, brain, and body. (Source)

Matthew Lieberman is a professor in Psychology at UCLA. He is the co-director of the SCN Lab. Lieberman received his Ph.D. from Harvard University and his BA from Rutgers College. (Source)

Major Depressive Disorder is Associated with Altered Functional Brain Response During Anticipation and Processing of Heat Pain

Irina A. Strigo et al.General Psychiatry. 2008 November: Vol. 65(11):1275-1284

Summary Chronic pain and depression are highly co-morbid conditions (strongly correlated). This study demonstrated that young adults with major depressive conditions demonstrated an increased emotional reactivity during the anticipation of heat pain. It was concluded that this anticipatory brain response may indicate hyper-vigilance to impending threat, which may lead to increased helplessless and an impaired ability to process pain normally. (Source)

Cerebral activation during hypnotically induced and imagined pain.

Derbyshire et al.

Neuroimage 2004 Sep;23(1):392-401.

Summary:

This is a really important study which demonstrates how non-structurally based pain can be generated in the brain - which is distinct from imagined pain. This demonstrates that pain can be "real" and yet still originate from the brain.

Abstract

The continuing absence of an identifiable physical cause for disorders such as chronic low back pain, atypical facial pain, or fibromyalgia, is a source of ongoing controversy and frustration among pain physicians and researchers. Aberrant cerebral activity is widely believed to be involved in such disorders, but formal demonstration of the brain independently generating painful experiences is lacking. Here we identify brain areas directly involved in the generation of pain using hypnotic suggestion to create an experience of pain in the absence of any noxious stimulus. In contrast with imagined pain, functional magnetic resonance imaging (fMRI) revealed significant changes during this hypnotically induced (HI) pain experience within the thalamus and anterior cingulate (ACC), insula, prefrontal, and parietal cortices. These findings compare well with the activation patterns during pain from nociceptive sources and provide the first direct experimental evidence in humans linking specific neural activity with the immediate generation of a pain experience.

Treatments addressing pain-related fear and anxiety in patients with chronic musculoskeletal pain: a preliminary review.

K Bailey et al

Cognitive Behaviour Therapy 2010 Mar;39(1):46-63.

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[1]Summary:

This study look at the best ways to overcome the fear conditioned response that builds up in patients with chronic musculosekeltal pain conditions. Two methods are found to be most effective. Graded in vivo exposure, where patients gradually confront their feared activity a small amount at a time. And acceptance and commitment therapy which is a self awareness technique based on mindfulness. Both these methods are incorporated within TMS techniques

Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients.

J Burns et al.

Emotion: 2006 May;6(2):309-19.

Summary

This is a fascinating study which suggests that patient anger itself might be playing a role in the levels of chronic pain experienced. Abstract

Anger may have greater effects on chronic pain severity than other negative emotions and may do so by increasing muscle tension near the site of injury (symptom-specific reactivity). For patients with chronic low back pain (CLBP), relevant muscles are lower paraspinals (LP). Ninety-four CLBP patients and 79 controls underwent anger and sadness recall interviews. EMG and cardiovascular activity were recorded. Patients exhibited greater LP tension increases during anger and slower recovery than controls. Only patients showed greater LP reactivity during anger than sadness. For both groups, trapezius reactivity during anger and sadness did not differ. LP reactivity to anger correlated with everyday pain severity for patients. Anger-induced symptom-specific LP reactivity may be linked to chronic pain aggravation among CLBP patients.

Effects of anger suppression on pain severity and pain behaviors among chronic pain patients: evaluation of an ironic process model.

J Burns et al.

Health Psychology: 2008 Sep;27(5):645-52.

Summary:

This is a further study by J Burns et al to measure the effect of anger suppression on the level of chronic pain experienced. They conclude that suppressed anger may make pain worse. Taken together with the study above, this suggests that anger has a significant role in the levels of chronic lower back pain – and that the source of this anger needs to be addressed rather than suppressed.

Abstract [abridged]

OBJECTIVE: Evidence for links between anger inhibition or suppression and chronic pain severity is based mostly on studies with correlation designs. Following from ironic process theory, we proposed that attempts to suppress angry thoughts during provocation would increase subsequent pain intensity among chronic low back pain (CLBP) patients, and do so through paradoxically enhanced accessibility of anger. CONCLUSION: Attempts by CLBP patients to suppress anger may aggravate pain related to their clinical condition through ironically increased feelings of anger.

Thinking about movement hurts: the effect of motor imagery on pain and swelling in people with chronic arm pain.

Arthritis and Rheumatology 2008 May 15;59(5):623-31.

G Moseley et al

AbstractSummary

This is an important study as it demonstrates how simply imagining doing an arm related activity can actually cause measurable pain and swelling in patients with chronic pain conditions in their arms. This leads credence to the theory that the autonomic system and pain beliefs have a significant role in chronic pain.

Abstract [abridged]

OBJECTIVE: Chronic painful disease is associated with pain on movement, which is presumed to be caused by noxious stimulation. We investigated whether motor imagery, in the absence of movement, increases symptoms in patients with chronic arm pain.

CONCLUSION: Motor imagery increased pain and swelling in patients with chronic painful disease of the arm. The effect increased in line with the duration of symptoms and seems to be modulated by autonomic arousal and beliefs about pain and movement. The results highlight the contribution of cortical mechanisms to pain on movement, which has implications for treatment.

Stress Related Research

Stress and psychophysiological dysregulation in patients with fibromyalgia syndrome.

A Okifuji et al

Appl Psychophysiol Biofeedback. 2002 Jun;27(2):129-41.

Summary

This is another study which suggests a link between fibromylagia and abnormal stress processing.

Abstract

Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal pain disorder characterized by diffuse pain and associated psychophysiological symptoms. Despite extensive research in the past 3 decades, the etiology and pathophysiology of FMS and effective treatment approaches are yet to be delineated. Recently, it has been suggested that FMS may be related to hypofunctional stress systems, particularly in the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. Studies have demonstrated that patients with FMS exhibit lowered sympathoadrenal reactivity to stress. These findings seem to be consistent with the large volume of research indicating the inverse relationship between pain sensitivity and sympathetic reactivity. In this paper, we discuss the role of stress in the pain experience in general, stress in patients with FMS, and review the studies evaluating the ANS and HPA functions in response to various stressors.

Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: findings of a population-based prospective cohort study. J McBeth et al.

Arthritis and Rheumatism 2007 Jan;56(1):360-71.

Abstract Summary

This study demonstrated how abnormalities in the hypothalamic-pituitary-adrenal (HPA) stress-response system were predictive of who would develop chronic widespread pain amongst a group of psychosocially at risk subjects. This study highlights the importance of stress as a factor in chronic pain conditions.

Abstract [abridged]

METHODS: We conducted a population-based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. Of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function.

RESULTS: A total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post-dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17-10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52-3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64-8.42) were all associated with CWP. One or more of these 3 HPA factors identified 26 (92.9%) cases of new-onset CWP.

CONCLUSION: Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new-onset CWP.

The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers.

E Nahit et al Journal of Rheumatology 2001 Jun;28(6):1378-84.

Summary

This study demonstrated the strong correlation between work related stress and the existence of chronic pain conditions.

Abstract

OBJECTIVE: To determine the influence of short term work related psychosocial factors (work demands, job control, and social support) and psychological distress on regional pain syndromes.

METHODS: Newly employed workers were recruited from 12 occupational groups and information collected by questionnaire. [snip]

RESULTS: 1081 subjects (median age 23; interquartile range 20-27) were recruited to the study shortly after commencing employment: 261 (24%) reported low back pain, 221 (20%) reported shoulder pain, 93 (9%) reported wrist/forearm pain, and 222 (21%) reported knee pain. High levels of psychological distress were associated with increased likelihood of pain, with a trend observed between scores on the GHQ and the odds of pain in each of the 4 sites. Those who perceived their work as stressful most of the time were more likely to report back or shoulder pain than those who considered their work seldom stressful. Pace of work or job autonomy was less markedly related to pain at individual sites. Strong relationships were observed between psychological distress, job demands (stressful work, hectic work), low job control, and pain at multiple sites.

CONCLUSION: The study has shown that adverse work related psychosocial factors, in particular aspects of job demand and control, influence the reporting of regional musculoskeletal pain. This occurs even after only short term exposure. The odds of reporting these adverse exposures are increased when pain is reported at multiple sites.

Mental Stress Induces Transient Endothelial Dysfunction in Humans

Lorenzo Ghiadoni, Ann E. Donald, Mark Cropley,et al

Circulation. 2000 Vol. 102: 2473-2478

Abstract

Full Text

Summary

This study demonstrates the physical impact of even short bouts of mental stress on the body. They found that brief stressful situations could actually cause endothelial dysfunction - which is a proposed mechanism for both coronary artery disease and atherosclerosis

Abstract [abridged]

Endothelial function was studied in 10 healthy men and in 8 non–insulin-dependent diabetic men. Brachial artery flow-mediated dilation (FMD, endothelium dependent) and response to 50 µg of sublingual glyceryl trinitrate (GTN, endothelium independent) were measured noninvasively by use of high-resolution ultrasound before and after (30, 90, and 240 minutes) a standardized mental stress test. [snip]

These findings suggest that brief episodes of mental stress, similar to those encountered in everyday life, may cause transient (up to 4 hours) endothelial dysfunction in healthy young individuals. This might represent a mechanistic link between mental stress and atherogenesis. (Source)

About the Authors

Lorenzo Ghiadoni was supported by a grant from the Department of Internal Medicine'

Ann E. Donald was supported by a grant from the Coronary Artery Disease Research Association (CORDA), London, England'

Mark Cropley was supported by a grant from the Medical Research Council (MRC), UK

Fibromyalgia Research

Functional Magnetic Resonance Imaging Evidence of Augmented Pain Processing in Fibromyalgia

Richard H. Gracely, Frank Petzke, Julie M. Wolf, and Daniel J. Clauw

Arthritis &Rheumatism. May 2002. Vol. 46(5):1333–1343

Abstract

Summary

In this paper the researchers applied pressure to patients with Fibromyalgia as well as a to a control group while they were subjected to a functional MRI scan of their brain. They discovered that the same pressure applied to a patient with Fibromyalgia gives pain signals that register higher than patients from the control group. They summarise that patients with lower back pain that cannot be traced to a specific physical cause may have "abnormal" pain-processing pathways in their brains. .

About the Authors

Richard Gracely, Ph.D., received his doctorate from Brown University in 1977. In 1974, he began working in what is now the Pain and Neurosensory Mechanisms Branch, National Institutes of Dental and Craniofacial Research, National Institutes of Health, and was chief of the Clinical Measurement and Mechanisms Unit and an adjunct member of the Department of Anesthesia at Georgetown University Medical Center. His research focuses on the neural mechanisms responsible for pain abnormalities observed in chronic multisymptom illness and the experimental models of these syndromes. He currently is a professor in the Division of Rheumatology, Department of Internal Medicine and Department of Neurology at the University of Michigan and the VA Ann Arbor Healthcare System. (Source)

Julie Wolf received her doctorate in clinical psychology from the University of Connecticut in 2005. She also received her masters in clinical psychology from the University of Connecticut in 2002 and her BA in 1997 from Haverford College. She is a board certified licensed psychologist and currently is a Associate Research Scientist at the Yale Child Study Center in New Haven, CT. (Source)

Daniel Clauw is a Professor of Medicine in the Division of Rheumatology at the University of Michigan. He serves as Director of the Chronic Pain and Fatigue Research Center and Director of the Michigan Institute for Clinical and Health Research at the University of Michigan. Additionally, he serves as Associate Dean for Clinical and Translational Research within the University of Michigan Medical School. He attended the University of Michigan for both undergraduate and medical school studies and then completed his Internal Medicine residency and Rheumatology Fellowship at Georgetown University. He joined the faculty at Georgetown University in 1990, and while there, served as the Scientific Director of the Georgetown Chronic Pain and Fatigue Research Center. (Source)

Narrative Review: The Pathophysiology of Fibromyalgia

Aryeh M. Abeles; Michael H. Pillinger; Bruce M. Solitar; and Micha Abeles

Annals of Internal Medicine. May 15, 2007. Vol. 46(10): 727-735

Abstract

Full Text PDF

Summary

This discussion of the scientific literature on fibromylagia explains how fibromyalgia patients actually perceive pain in a different manner to the general population - in the absence of disease. They speculate that emotional and psychiatric states may actually effect the experience of pain.Abstract

The study of the pathophysiology of fibromyalgia presents a unique and complex set of challenges, beginning with the nosology of the illness. To date, the most productive approaches to studying pain mechanisms in fibromyalgia have come mostly from applying tools used in studying other forms of chronic pain. Indeed, accumulating evidence suggests that fibromyalgia probably results from abnormal central pain processing rather than a dysfunction in the peripheral tissues where such pain is perceived. Several mechanisms may be involved, including central sensitization, suppression of descending inhibitory pathways, excessive activity of glial cells, and abnormalities of neurotransmitter release or regulatory proteins or both. These mechanisms are probably not mutually exclusive. What is most clear is that patients with fibromyalgia experience pain differently than the general population, and they do so in the absence of disease. On the basis of the known and putative precipitants (and the conditions associated with fibromyalgia), emotional or psychiatric disturbance or both may effect and modulate pain processing to produce fibromyalgia in many patients. To be effective, future therapies for fibromyalgia will need to address the pain pathways involved in fibromyalgia; its associated comorbid conditions; or, more likely, both. (Source)

Decreased Gray Matter Volumes in the Cingulo-Frontal Cortex and the Amygdala in Patients with Fibromyalgia

Markus Burgmer, et al.

Psychosomatic Medicine. 2009. Vol. 71:566-573

Summary

This study demonstrates that a potential mechanism for fibromyalgia is reduced gray matter in parts of the brain which affects the processing of pain. Abstract

Studies in fibromyalgia syndrome with functional neuroimaging support the hypothesis of central pain augmentation. To determine whether structural changes in areas of the pain system are additional preconditions for the central sensitization in fibromyalgia we performed voxel based morphometry in patients with fibromyalgia and healthy controls. Methods: We performed 3 Tesla magnetic resonance imaging of the brain in 14 patients with fibromyalgia and 14 healthy controls. Regional differences of the segmented and normalized gray matter volumes in brain areas of the pain system between both groups were determined. In those areas in which patients structurally differed from healthy controls, the correlation of disease-related factors with gray matter volumes was analyzed. Results: Patients presented a decrease in gray matter volume in the prefrontal cortex, the amygdala, and the anterior cingulate cortex (ACC). The duration of pain or functional pain disability did not correlate with gray matter volumes. A trend of inverse correlation of gray matter volume reduction in the ACC with the duration of pain medication intake has been detected. Conclusions: Our results suggest that structural changes in the pain system are associated with fibromyalgia. As disease factors do not correlate with reduced gray matter volume in areas of the cingulo-frontal cortex and the amygdala in patients, one possible interpretation is that volume reductions might be a precondition for central sensitization in fibromyalgia. (Source)

Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: an fMRI analysis.

S Derbyshire et al.

European Journal of Pain 2009 May;13(5):542-50. Epub 2008 Jul 23.

Abstract Summary:

This study used hypnosis to measure the effects of hypnotic suggestion on subjective reporting of pain amongst fibromyalgia patients. By measuring the corresponding brain activity the authors conclude that there is direct evidence that regions of the brain involved in the experience of pain are actively involved in the generation of fibromyalgia pain.

Abstract (abridged)

The neuropsychological status of pain conditions such as fibromyalgia, commonly categorized as 'psychosomatic' or 'functional' disorders, remains controversial. Activation of brain structures dependent upon subjective alterations of fibromyalgia pain experience could provide an insight into the underlying neuropsychological processes. To explore these and related questions, suggestions following a hypnotic induction and the same suggestions without a hypnotic induction were used during functional magnetic resonance imaging to increase and decrease the subjective experience of fibromyalgia pain. Suggestion in both conditions resulted in significant changes in reported pain experience, although patients claimed significantly more control over their pain and reported greater pain reduction when hypnotised. [Our results] indicate direct involvement of a network of areas widely associated with the pain 'neuromatrix' in fibromyalgia pain experience. These findings extend beyond the general proposal of a neural network for pain by providing direct evidence that regions involved in pain experience are actively involved in the generation of fibromyalgia pain.

[Fibromyalgia: interfaces to RSI and considerations about work etiology] (in Portuguese)

T Alvares et al

Ciencia & Saude coletiva 2010 May;15(3):803-12.

Summary:

This is an interesting study which compares RSI and fibromyalgia to see if they share a common cause. It notices that workload and emotional stress are important factors in development of these conditions.

Abstract

Two groups of patients, one presenting symptoms of fibromyalgia and previous diagnostics of RSI (Repetitive Strain Injury), and the other only with fibromyalgia were compared in attempt to comprehend the relations between these two conditions and also between fibromyalgia and work. It was used the biographical method, with detailed interviews and creation of clinical cases from six patients with fibromyalgia, three of each group. It was noticed that patients from the first group showed a clear relationship between the disease's evolution and the overload of work. The patients of second group showed some of the symptoms since childhood or adolescence that became worse after they had suffered an emotionally strong impact. Also, these patients reported cases of similar symptoms of fibromyalgia in their families, on the contrary of the first group. It was conclude that in some patients with fibromyalgia, the overload work is an important etiologic factor, and could be preceded by RSI. In these cases the diagnosis of fibromyalgia could be used as an attempt of disassociate the relation between symptoms and the work, preventing the worker to get social security benefits.

Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management.

C Cedradhi et al

Annals of the Rheumatic Diseases 2004 Mar;63(3):290-6.

Summary:

This randomised controlled trial noted that significant improvements in quality of life were achieved by a treatment group who treated their fibromylagia with a 6 week program of self management techniques, pool exercises and education. These improvements extended to increased functional capacity, and reduced levels of depression, fatigue and anxiety and were sustained for at least 6 months after the programme's conclusion.

Edited Abstract:

RESULTS: 61 participants in the treatment group and 68 controls completed the programme and 6 month follow up examinations. Six months after programme completion, significant improvements in quality of life and functional consequences of FM were seen in the treatment group as compared with the controls and as measured by scores on both the FIQ (total score p = 0.025; fatigue p = 0.003; depression p = 0.031) and PGWB (total score p = 0.032; anxiety p = 0.011; vitality p = 0.013,)

A painful train of events: increased prevalence of fibromyalgia in survivors of a major train crash.

D Buskila et al.

Clinical and Experimental Rheumatology 2009 Sep-Oct;27(5 Suppl 56):S79-85.

Abstract Summary:

This study followed survivors a major train crash 3 years following the event. They found highly prevalent levels of fibromylagia amongst survivors (15%). This is consistent with other studies which suggest that Post Traumatic Stress Disorder and fibromyalgia may be overlapping conditions. They conclude that individuals who suffer both emotional and physical trauma are at significant risk of developing fibromyalgia. They also note that fibromylagia sufferers report a large number of emotional problems. This study would indicate that a mindbody approach is important in treating the condition.

Abstract [abridged]

RESULTS: Fifteen percent of survivors participating in the study met ACR criteria for the classification of fibromyalgia. Significantly lower rates of physical and emotional functioning were found among survivors with fibromyalgia compared with those not meeting the classification criteria. Survivors with fibromyalgia rated significantly higher on scales of somatisation, obsessive-compulsive ideation, interpersonal sensitivity, depression, anger and hostility, phobic and general anxiety, paranoid ideation and psychoticism. Survivors with fibromyalgia also rated significantly higher on scales of posttraumatic symptoms including intrusion, avoidance and arousal.

CONCLUSION: Fibromyalgia was found to be highly prevalent, three years after a major train crash, among individuals exposed to the combination of physical injury and extreme stress. This finding is in accordance with previous data regarding the association of fibromyalgia with both physical and emotional trauma and calls attention to studying the underlying susceptibility factors which may partake in this association.

One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders.

P Fink et al

Journal of Psychosomatic Research 2010 May;68(5):415-26.

Abstract Summary:

This is an interesting study which investigated whether a number of disparate poorly understood conditions could be successfully grouped together under the term “bodily distress syndrome.” They conclude that this new term successfully captured fibromyalgia, chronic fatigue syndrome, hyperventilation syndrome, irritable bowel syndrome, non-cardiac chest pain, pain syndrome and other somatoform disorders.

Abstract [abridged]

Conclusion: Bodily distress syndrome seem to cover most of the relevant "somatoform" or "functional" syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.

Sustained Pain Reduction Through Affective Self-awareness in Fibromyalgia: A Randomized Controlled Trial

Michael Hsu, Howard Schubiner, Mark Lumley, John Stracks, et alJournal of Internal Medicine

Abstract

TMS In The Media#reuters

Summary

This study led by Dr. Howard Schubiner examined the effectiveness of "affective self-awareness" treatment protocol in patients diagnosed with Fibromyalgia. The participants were all women, and 46% reported at least a 30% drop in pain severity. The treatment used on these patients included journal exercises and mindfulness techniques. It shows that a "TMS treatment approach" can reduce pain in patients.

About the Authors

Dr. Howard Schubiner is board-certified in pediatrics, adolescent medicine, and internal medicine. He was a full Professor at Wayne State University for 18 years and now works at Providence Hospital in Southfield, MI, where he directs the the Mind Body Medicine Program that he founded. This program uses cutting edge research and both meditative and cutting edge psychological techniques to treat individuals who suffer from TMS. He says "Many of us suffer needlessly from pain diagnosed as migraines, tension headaches, fibromyalgia, or chronic neck, back, abdominal, and pelvic pain, when the real cause is Mind Body Syndrome." His new book Unlearn Your Pain was published in February 10. (Source)

John Stracks is board certified in family medicine and received his medical degree from the University of Chicago Pritzker School of Medicine. He is interested in integrative medicine, mind body programs and the mind body syndrome. Currently Dr. Stracks is practicing medicine at the Northwestern Memorial Physicians Group Center for Integrative Medicine and Wellness. Dr. Stracks believes that treatment plans need to include a mind and body component along with a social and spiritual component as well. Changes in nutrition, activity level, and other lifestyle areas can dramatically improve a person's health. (Source)

RSI, Hip Pain and other musculoskeletal research

Carpal Tunnel Syndrome Study Stirs Controversy

M. Larkin

The Lancet, June 16, 2001. Volume 357 (9272).

Abstract'

Summary

A recent study examined the extent computer use has in Carpal Tunnel Syndrome causation. The study found that computer use, even working 6-5 hours a day, does not increase the risk of Carpel Tunnel Syndrome. This surprising finding is outlined in this article along with responses from other experts researching Carpel Tunnel Syndrome. (Source)

Hip Pain in Athletes

S Adkins, R. Figler

American Family Physician, 2000. Vol. 61:2109-2118. Abstract

Summary

Athletes of all ages are at risk of injury. These injuries can vary greatly to extent and area of injury. Despite the variety of different injuries, athletes are at a particular risk of hip injury and hip pain. This article gives a detailed account of the specific hip pain and hip injuries athletes may exhibit depending on their age. The most common pain in prepubescent children is Transient synovitis, which can be seen in children who exhibit a sudden limp in their leg. The article found that slipped capital femoral epiphysis is found more often in adolescent children. Due to the high intestity of the sport, young adults appeared to have the longest list of possible hip injuries with femoral neck stress fracture the most common. Lastly the study found that hip injuries in older patients was most likely to be degenerative arthritis in the hip joint. While the article does not mention TMS directly it does give a description of the pain treatment and medical procedures in diagnosing pain. (Source)

About the Authors

Samuel B. Adkins III, M.D. is assistant professor of family medicine and residency director of the family medicine residency program at East Carolina University School of Medicine, Greenville, N.C. Dr. Adkins received a medical degree from the University of Pittsburgh (Pa.) School of Medicine. He completed a residency in family medicine at St. Margaret Memorial Hospital, Pittsburgh, and a faculty development fellowship at the University of North Carolina, Chapel Hill, N.C. East Carolina University School of Medicine, Greenville, North Carolina. (Source)

Richard A. Figler, M.D. is clinical instructor of family medicine at East Carolina University School of Medicine. He completed a family medicine residency at East Carolina University and is a faculty development fellow there. He received a medical degree from Case Western Reserve University School of Medicine, Cleveland, Ohio. (Source)

Predicting the onset of knee pain: results from a 2-year prospective study of new workers.

Jones et al G Jones et al

Annals of Rheumatic Disease 2007 Mar;66(3):400-6. Epub 2006 Aug 25.

Summary: This study shows that psychosocial factors are an important risk factor in the development of knee pain.

Abstract

OBJECTIVE: To determine the relative contribution of work-related mechanical (injury) factors and psychosocial factors to the onset of a new episode of knee pain, in a cohort of newly employed workers.

METHODS: A prospective cohort study of newly employed workers from 12 diverse occupational settings in England (The New Workers Study). 859 newly employed workers, free of knee pain, were identified. Information about occupational mechanical factors (manual handling and postural activities), the occupational physical environment, and psychological and psychosocial factors was collected by self-completion questionnaires. Participants were followed up after 12 and 24 months to identify cases of knee pain onset. Generalised estimating equations were used to estimate the risk of new-onset knee pain, with respect to the exposures previously measured.

RESULTS: In total, over the 2-year follow-up period, 108 cases of new-onset knee pain were observed. Mechanical load, postural factors, psychological distress and work-place psychosocial factors all influenced the risk of new-onset knee pain over the 2-year follow-up period. On multivariate analysis, two factors remained independently predictive of knee pain onset: lifting or carrying heavy weights in one hand, and the level of general psychological distress.

CONCLUSION: In addition to mechanical (injury) factors, psychological factors are important risk factors for knee pain onset as shown in a population of young newly employed workers.

Meditation and Journaling Research

Nonverbal and verbal emotional expression and health

D. Berry, JW Pennebaker

Psychotherapy and Psychosomatics. Vol 59(1), 1993, 11-19.

Summary

This paper demonstrates how simply expressing traumatic experiences through either talking or journaling improves both physical health and immune function.Abstract

The spontaneous nonverbal expression of emotion is related to immediate reductions in autonomic nervous system activity. Similar changes in specific autonomic channels occur when individuals are encouraged to verbally express their emotions. Indeed, these physiological changes are most likely to occur among individuals who are either verbally or nonverbally highly expressive. These data suggest that when individuals must actively inhibit emotional expression, they are at increased risk for a variety of health problems. Several experiments are summarized which indicate that verbally expressing traumatic experiences by writing or talking improves physical health, enhances immune function, and is associated with fewer medical visits. Although less research is available regarding nonverbal expression, it is also likely that the nonverbal expression of emotion bears some relation to health status. We propose that the effectiveness of many common expressive therapies (e.g., art, music, cathartic) would be enhanced if clients are encouraged to both express their feelings nonverbally and to put their experiences into words. (source)

Effects of Writing About Stressful Experiences on Symptom Reduction in Patients With Asthma or Rheumatoid Arthritis: A Randomized Trial Joshua Smyth

Journal of the American Medical Association. April 14, 1999. Volume 281(14):1304-1309. Abstract

Other Works by Author'

Summary

There is also published evidence which speaks to the medical benefit gained by expressing emotions through journaling. Joshua Smith et al. conducted a study on rheumatoid arthritis and asthma sufferers. The experimental group wrote for 3 consecutive days a week on stressful experiences, the control group about their plans for the day. They found significant clinical improvements for both asthma and rheumatoid arthritis sufferers against the control group in objective measures.

Abstract [abridged]

Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving.

About the Author

Joshua Smyth is currently a Professor in the Department of Psychology at Syracuse University in its Center for Health and Behavior. His research area is comprised of three areas. (1) What are the effects of experiencing stress or trauma on psychological and physical well-being (2) Can we assess stress, affect, and health in an ecologically relevant manner that facilitates our understanding of biopsychosocial processes as they unfold in time and in context? (3) Can psychological interventions improve health and well-being, both in healthy individuals and individuals with existing physical or psychiatric illness? (Source)

The Effects of Brief Mindfulness Meditation Training on Experimentally Induced Pain Fadel Zeidan, Nakia Gordon, et al.

The Journal of Pain (published online 23 October 2009).

Summary

This study demonstrates the effectiveness of a short course of mindfulness meditation on both reducing reported pain and anxiety.

Abstract

This study investigated the effects of brief mindfulness meditation training on ratings of painful electrical stimulation. In Experiment 1, we used a 3-day (20 min/d) mindfulness meditation intervention and measured pain ratings before and after the intervention. Participants' numerical ratings of pain to “low” and “high” electrical stimulation significantly decreased after meditation training. Pain sensitivity, measured by change in stimulus intensity thresholds, also decreased after training. We investigated, in Experiment 2, how well relaxation and a math distraction task attenuated experimental pain. Math distraction but not relaxation reduced high pain ratings. There was no reduction in pain sensitivity in these participants. In Experiment 3, we directly compared the effects of meditation with math distraction and relaxation conditions. Our findings indicated significant effects of both meditation and math distraction. Consistent with what was observed in Experiment 1, these participants also demonstrated a decrease in pain sensitivity after meditation training. Changes in the mindfulness and anxiety assessments suggest that meditation's analgesic effects are related to reduced anxiety and the enhanced ability to focus on the present moment. Our findings indicate that a brief 3-day mindfulness meditation intervention was effective at reducing pain ratings and anxiety scores when compared with baseline testing and other cognitive manipulations. The brief meditation training was also effective at increasing mindfulness skills. (source)

The effects of slow breathing on affective responses to pain stimuli: An experimental study A Craig et al Journal of the International Association for the Study of Pain, published online 15 January 2010.

Abstract

Summary

This research shows that controlled breathing at a slowed rate can significantly reduce feelings of pain. Chronic pain sufferers, specifically fibromyalgia (FM) patients, reported less pain while breathing slowly, unless they were overwhelmed by negative feelings, sadness or depression. The findings offer an explanation for prior reports that mindful Zen meditation has beneficial effects on pain and that yogic breathing exercises can reduce feelings of depression. These results also underline the role that a person's positive or negative attitude can have on their feelings of pain.

About the Authors

The research was led by Arthur (Bud) Craig, PhD, at Barrow, and was done in collaboration with investigators in the Department of Psychology at Arizona State University. It was published recently in PAIN, the refereed journal of the International Association for the Study of Pain (IASP). (Source)

The clinical use of mindfulness meditation for the self-regulation of chronic pain.

Journal of Behavioural Medicine 1985 Jun; Vol. 8(2):163-90.

Kabat-Zinn J et al.

Summary

This study shows how mindfulness meditation significantly reduced chronic pain, anxiety and depressio in a group of subjects.

Abstract

Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. (Source)

Mindfulness-based stress reduction and health benefits. A meta-analysis

Journal of Psychosomatic Research, Vol. 57(1): 35-43

P.Grossman et al. Abstract

Summary

This was a meta-analysis (where a number of studies are compared) of the evidence for the health benefits of mindfulness. They take into account a large number of different diseases and conditions and conclude that mindfulness-based stress reduction may help patients cope with their clinical and non clinical problems.

Abstract

Mindfulness based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic and psychiatric disorders. We performed a comprehensive review and meta-analysis of published and unpublished studies of health related studies related to MBSR.

64 empirical studies were found but only 20 reports met criteria of acceptable quality or relevance to be included in the meta-analysis. Acceptable studies covered a wide spectrum of clinical populations (e.g., pain, cancer, heart disease, depression, and anxiety), as well as stressed nonclinical groups. Both controlled and observational investigations were included. Standardized measures of physical and mental well-being constituted the dependent variables of the analysis.

Overall, both controlled and uncontrolled studies showed similar effect sizes of approximately 0.5 (P<.0001) with homogeneity of distribution.

Although derived from a relatively small number of studies, these results suggest that MBSR may help a broad range of individuals to cope with their clinical and non-clinical problems. (Source)

The impact of a meditation-based stress reduction program on fibromyalgia.

General Hospital Psychiatry Sep; Vol. 15(5):284-9.

Kaplan KH et al.

Summary:

This study demonstrates that meditation might be a useful tool in reducing pain, fatigue and anxiety in fibromyalgia sufferers.

Abstract

Fibromyalgia is a chronic illness characterized by widespread pain, fatigue, sleep disturbance, and resistance to treatment. The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia. Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program. Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity. Patients were evaluated before and after the program. Initial evaluation included a psychiatric structured clinical interview (SCID). Outcome measures included visual analog scales to measure global well-being, pain, sleep, fatigue, and feeling refreshed in the morning. Patients also completed a medical symptom checklist, SCL-90-R, Coping Strategies Questionnaire, Fibromyalgia Impact Questionnaire, and the Fibromyalgia Attitude Index. Although the mean scores of all the patients completing the program showed improvement, 51% showed moderate to marked improvement and only they were counted as "responders." These preliminary findings suggest that a meditation-based stress reduction program is effective for patients with fibromyalgia. (Source)

Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being.

Psychotherapy and Psychosomatics 2007; Vol. 76(4):226-33.

P Grossman et al.

Summary:

This study also demonstrates the usefulness of meditation in reducing pain, fatigue and anxiety in fibromyalgia sufferers. Health benefits were maintained on a 3 year follow up.

Abstract

BACKGROUND: Mindfulness-based stress reduction (MBSR) proposes a systematic program for reduction of suffering associated with a wide range of medical conditions. Studies suggest improvements in general aspects of well-being, including quality of life, coping and positive affect, as well as decreased anxiety and depression. METHODS: A quasi-experimental study examined effects of an 8-week MBSR intervention among 58 female patients with fibromyalgia (mean, 52 +/- 8 years) who underwent MBSR or an active social support procedure.

RESULTS: Pre- to postintervention analyses indicated MBSR to provide significantly greater benefits than the control intervention on most dimensions, including visual analog pain, Quality of Life subscales, coping with pain, anxiety, depression and somatic complaints (Cohen d effect size, 0.40-1.10). Three-year follow-up analyses of MBSR participants indicated sustained benefits for these same measures (effect size, 0.50-0.65).

CONCLUSIONS: Based upon a quasi-randomized trial and long-term observational follow-up, results indicate mindfulness intervention to be of potential long-term benefit for female fibromyalgia patients. (Source)

A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction.

The Journal of Alternative Medicine 2008 Apr; Vol. 14(3):251-8.

Smith BW et al.

Summary

This study compared the efficiacy of two different mindbody techniques- mindfulness-based stress reduction (MBSR) and cognitive-behavioral stress reduction (CBSR). They conclude that both methods may be effective in reducing perceived stress levels and depression, but that MBSR may be more effective in reducing pain.

Abstract

OBJECTIVES: The objective of this pilot study was to compare the effects of two mind-body interventions: mindfulness-based stress reduction (MBSR) and cognitive-behavioral stress reduction (CBSR). SUBJECTS: Fifty (50) subjects were recruited from the community and took part in MBSR (n = 36) and CBSR (n = 14) courses. Participants self-selected into MBSR or CBSR courses taught at different times. There were no initial differences between the MBSR and CBSR subjects on demographics, including age, gender, education, and income. INTERVENTION: MBSR was an 8-week course using meditation, gentle yoga, and body scanning exercises to increase mindfulness. CBSR was an 8-week course using cognitive and behavioral techniques to change thinking and reduce distress.

RESULTS: MBSR subjects improved on all eight outcomes, with all of the differences being significant. CBSR subjects improved on six of eight outcomes, with significant improvements on well-being, perceived stress, and depression. Multivariate analyses showed that the MBSR subjects had better outcomes across all variables, when compared with the CBSR subjects. Univariate analyses showed that MBSR subjects had better outcomes with regard to mindfulness, energy, pain, and a trend for binge eating.

CONCLUSIONS: While MBSR and CBSR may both be effective in reducing perceived stress and depression, MBSR may be more effective in increasing mindfulness and energy and reducing pain. Future studies should continue to examine the differential effects of cognitive behavioral and mindfulness-based interventions and attempt to explain the reasons for the differences. (Source)

Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers

BA Esterling, MH Antoni, et al.

Journal of Consulting and Clinical Psychology, 1994, Vol 62(1): 130-140

Summary

This study demontrates the benefit of talking or writing about stressful events. These actions actually led to biologically measureable changes in the body.

Abstract

Healthy Epstein-Barr virus (EBV) seropositive undergraduates (N = 57) completed a personality inventory, provided blood samples, and were randomly assigned to write or talk about stressful events, or to write about trivial events, during three weekly 20-min sessions, after which they provided a final blood sample. Individuals assigned to the verbal/stressful condition had significantly lower EBV antibody titers (suggesting better cellular immune control over the latent virus) after the intervention than those in the written/stressful group, who had significantly lower values than those in the written/trivial control group. Subjects assigned to the written/stressful condition expressed more negative emotional words than the verbal/stressful and control groups and more positive emotional words than the verbal/stressful group at each time point. The verbal/stressful group expressed more negative emotional words compared with the control group at baseline. Content analysis indicated that the verbal/stressful group achieved the greatest improvements in cognitive change, self-esteem, and adaptive coping strategies. (source)

About the Author

Michael Antoni is a professor at the University of Miami. He is the Director of the Center for Psycho-Oncology Research, as well as the Editor for the International Journal of Behavioral Medicine, Psychology and Health. His research interests are focused in psychoneuroimmunology (PNI) particularly as it applies to certain human cancers and viral infections such as HIV-1 infection. (Source)

Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach.

M Sadlier et al

The Journal of Laryngology and Ontology 2008 Jan;122(1):31-7. Epub 2007 Apr 23.

Summary

This study concludes that there is evidence to support the use of both cognitive behavioural therapy and meditation in the treatment of tinnitus.

Abstract

BACKGROUND: Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers.

METHODOLOGY: Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted. RESULTS: These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period.

CONCLUSION: The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

Alterations in Brain and Immune Function Produced by Mindfulness Meditation

R Davidson et al.

Psychosomatic Medicine 65:564-570 (2003)

Abstract Summary

This study demonstrates that a short program of mindfulness meditation actually produces physically measurable changes in the brain, and in immune function.

Abstract

OBJECTIVE: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees.

METHODS: We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine.

RESULTS: We report for the first time significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine.

CONCLUSIONS: These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.

Whiplash Research

Natural evolution of late whiplash syndrome outside the medicolegal context

H. Schrader, D. Obelienniene, G. Bovim, D. Surkiene, D. Mickeviciene, L. Miseviciene, et al.

Lancet. 1996; Vol. 347

Summary

Most Lithuanian automobile drivers and passengers are not covered by insurance, and it is rare for someone to report a whiplash injury. This study took over 200 people from Lithuania and interviewed them after 1-3 years after experiencing a rear-end automobile accident. This group was compared against a sex-matched and age-matched control group of uninjured people. The study investigated the percentage of people that reported they had Neck and back pain, subjective cognitive dysfunction, psychological disorders. The comparison saw no significant difference in the amount of pain reported between the two groups. Not one person in the study group had disabling or persistent symptoms resulting from the automobile collision. The article suggests that other factors such as patient history are better determinants for the resulting whiplash syndrome. This study is important to TMS research because it suggests that the on-set of chronic pain, such as neck pain, can be caused not by a physical event, but by an emotional reaction to an event or situation. (Source)

The best approach to the problem of whiplash? One ticket to Lithuania, please

R. Ferrari, O. Kwan, AS Russell, H. Schrader, JMS Pearce

Clin Exp Rheumatol. May-June 1999. Vol. 17(3):321-6

Abstract

Full-Text

Summary

This article looks at the Quebec Task Force on Whiplash Associated Disorders and determined that after three years the Task Force's recommendations have not been implemented. The article suggested that the therapeutic community should be more involved in solving and treating the whiplash syndrome. A biopsychosocial model for whiplash treatment, which considers the expectation of injury in chronic pain reporting is the primary model for whiplash treatment. (Source)

No stress - no whiplash? Prevalence of "whiplash" symptoms following exposure to a placebo rear-end collision

WH Castro, SJ Meyer, ME Becke, CG Nentwig, MF Hein, Bl Ercan, et al

International Journal of Legal Medicine. 2001, Vol. 114: 316-22

Abstract

Cited By'

Summary

This study investigates the cause of symptom expectation in regards to automobile collisions and whiplash syndrome. Study participants were placed in placebo automobile collisions that lacked physical and biomechanical stress. The experiment was designed in a way so the participants would not be physically harmed. Some of the participants reported they had neck and back pain from the experimental collision, even though the test lacked any biomechanical stress. This suggest that the participants neck and back pain resulted from symptom expectation or emotional stress caused by the collision. This study correlates with the TMS approach that some chronic pain is caused by emotional and psychological factors. (Source)

Pain after whiplash: a prospective controlled inception cohort study

Diana Obelieniene, Harald Schrader, Gunnar Bovim, Irena Misevic, Trond Sand

J Neurol Neurosurg Psychiatry. 1999. Vol.66: 279–283<a href="http://jnnp.bmj.com/content/66/3/279.abstract">

Abstract</a>

Summary

In a country were there is no preconceived notion of chronic pain arising from rear end collisions, and thus no fear of long term disability, and usually no involvement of the therapeutic community, insurance companies, or litigation, symptoms after an acute whiplash injury are self limiting, brief, and do not seem to evolve to the so-called late whiplash syndrome.