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Biomedical subjects

Christopher Eccleston

Publications and source records attributed to Christopher Eccleston.

35 records · Page 2Linked to original sources
PubMed2005

Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase.

The concept of acceptance is receiving increased attention as an alternate approach to the suffering that is often associated with persistent and disabling pain. This approach differs from established treatments in that it does not principally focus on reducing pain, but on reducing the distressing and disabling influences of pain as they concern important areas in patients' lives. The present analyses represent a preliminary evaluation of an acceptance-based approach to chronic pain within an interdisciplinary treatment program. One hundred and eight patients with complex chronic pain conditions completed treatment and provided data for the current study. Treatment was conducted in a 3- or 4-week residential or hospital-based format. It included a number of exposure-based, experiential, and other behavior change methods focused on increasing (a) engagement in daily activity regardless of pain and (b) willingness to have pain present without responding to it. Significant improvements in emotional, social, and physical functioning, and healthcare use were demonstrated following treatment. The majority of improvements continued at 3-months post-treatment. Improvements in most outcomes during treatment were correlated with increases in acceptance, supporting the proposed process of treatment.

Activities of Daily Living↗
PubMed2005

Clinical assessment of behavioral coping responses: preliminary results from a brief inventory.

Patients and clinicians sometimes take coping with chronic pain primarily as a process of gaining more control over pain. An alternate approach might include helping the pain sufferer to discriminate parts of their situation that can be effectively controlled from those that cannot. When faced with situations that do not yield to attempts at direct control patients may gain better results from leaving those situations as they are and investing their efforts elsewhere. This study was designed to examine this type of expanded view of coping with pain, a view that includes both attempts at control and acceptance. 200 adults seeking treatment for chronic pain were the subjects of this investigation. They completed a number of self-report inventories including a measure called the Brief Pain Coping Inventory, an inventory assessing accepting responses to pain as well as pain management responses standardly targeted by cognitive-behavioral treatment methods. Preliminary results showed that the BPCI yields scores with adequate temporal consistency and validity. Further results showed that a number of the responses assessed by the BPCI were reliable predictors of patient functioning. In general less frequent struggling to control pain, fewer palliative and avoidant coping responses, and more explicit persistence with activity despite acknowledged pain were associated with less depression and anxiety and greater life functioning. These results demonstrate that, in some instances, attempts at avoidance and control of chronic pain may be less helpful compared with a willingness to experience pain and focus on functioning.

Activities of Daily Living↗
PubMed2005

A scale for rating the quality of psychological trials for pain.

This paper reports the development of a scale for assessing the quality of reports of randomised controlled trials for psychological treatments. The Delphi method was used in which a panel of 15-12 experts generated statements relating to treatment and design components of trials. After three rounds, statements with high consensus agreement were reviewed by a second expert panel and rewritten as a scale. Evidence to support the reliability and validity of the scale is reported. Three expert and five novice raters assessed sets of 31 and 25 published trials to establish scale reliability (ICC ranges from 0.91 to 0.41 for experts and novices, respectively) and item reliability (Kappa and inter-rater agreement). The total scale score discriminated between trials globally judged as good and poor by experts, and trial quality was shown to be a function of year of publication. Uses for the scale are suggested.

Humans↗
PubMed2004

Fear-conditioned cues of impending pain facilitate attentional engagement.

AIMS OF STUDY: Selective attention to signals of impending pain allows the avoidance of bodily harm. In order to identify the attentional components involved in the selection of pain signals over competing demands, we used an emotional modification of an exogenous cueing task. METHODS: Fifty-two pain-free volunteers detected visual targets of which the location was correctly or incorrectly predicted by a spatial cue. Cues were emotionally modulated using differential classical conditioning. The conditioned cue (CS+) was sometimes followed by an electrocutaneous stimulus (UCS), thus becoming a pain signal, whereas the UCS never followed the other cue (CS-), referred to as safety signal. RESULTS: Analyses of response times showed that pain signals facilitated the directing of attention to their location in comparison to safety signals. In contrast, pain signals did not impair disengagement of attention from their location in comparison to safety signals. CONCLUSION: It is concluded that attention is more strongly engaged to a signal of impending pain compared with a cue signalling its absence. We explore why disengagement from the pain signal is not impaired compared to the safety signal. The findings are discussed in terms of the defensive importance of pain anticipation.

Adult↗
PubMed2004

Disengagement from pain: the role of catastrophic thinking about pain.

This paper reports an experimental investigation of attentional engagement to and disengagement from pain. Thirty-seven pain-free volunteers performed a cueing task in which they were instructed to respond to visual target stimuli, i.e. the words 'pain' and 'tone'. Targets were preceded by pain stimuli or tone stimuli as cues. Participants were characterized as high or low pain catastrophizers, using self-reports. We found that the effect of cueing upon target detection was differential for high and low pain catastrophizers. Analyses revealed a similar amount of attentional engagement to pain in both groups. However, we also found that participants high in pain catastrophizing had difficulty disengaging from pain, whereas participants low in pain catastrophizing showed no retarded disengagement from pain. Our results provide further evidence that catastrophic thinking enhances the attentional demand of pain, particularly resulting in difficulty disengaging from pain. The clinical implications of these findings are discussed.

Acoustic Stimulation↗
PubMed2004

Acceptance of chronic pain: component analysis and a revised assessment method.

Acceptance of chronic pain entails that an individual reduce unsuccessful attempts to avoid or control pain and focus instead on participation in valued activities and the pursuit of personally relevant goals. Recent research suggests that pain-related acceptance leads to enhanced emotional and physical functioning in chronic pain patients above and beyond the influence of depression, pain intensity, and coping. In these studies, acceptance was measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Preliminary analyses of the CPAQ have supported its psychometric properties. The present study sought to further refine the CPAQ by examining its factor structure and evaluating the relations of these factors to other indices of pain-related distress and disability. Although a previously demonstrated factor structure of the CPAQ was generally supported, only factors assessing (a) the degree to which one engaged in life activities regardless of the pain and (b) willingness to experience pain had adequate reliability and validity and were significantly related to the other measures of patient functioning. A revised version of the CPAQ is suggested.

Adaptation, Psychological↗
PubMed2004

Adolescent chronic pain: patterns and predictors of emotional distress in adolescents with chronic pain and their parents.

Adolescents with chronic pain also report severe disability and emotional distress. A clinical sample of 80 adolescents and accompanying parents were investigated to first measure the extent of distress, and second to investigate the relationships between adolescent distress, parental distress and adolescent coping. Measures of pain intensity, anxiety, depression, disability and coping were obtained from adolescents. Parents completed measures including their own anxiety, depression and parenting stress. Overall, adolescents reported high levels of disability, depression and anxiety, and parents reported high levels of depression, anxiety and parenting stress. Multiple regression analyses revealed that the best predictors of adolescent emotional distress were the extent to which the adolescents catastrophize and seek social support to cope with the pain. There were no clear predictors of parental anxiety or depression but the specific pattern of parenting stress was best predicted by the younger age of the adolescent, the greater the chronicity of the problem, and the greater the extent of adolescent depression. These findings suggest that emotional coping is a critical variable in the distress associated with adolescent chronic pain. It is argued that adolescent emotional coping may best be understood within a relational context of seeking emotional support.

Adaptation, Psychological↗
PubMed2004

Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain.

The aim of this study was to investigate the effects of distraction from pain during and after a pain-inducing lifting task in a sample of chronic low back pain (CLBP) patients. Fifty-two CLBP patients (25 males, 27 females; mean age=46.30 years) performed a pain-inducing lifting task twice, once alone and once with a simultaneous cognitive distraction task. The results revealed that (1) distraction had no effect upon self-reported pain during the lifting task, (2) distraction had a paradoxical effect of more pain immediately after the lifting task, (3) both pain-related fear and pain catastrophizing did not moderate the effects of distraction on pain, but (4) catastrophic thinking about pain during the lifting task was related to more vigilance to pain and less engagement in the distracting task. Further investigation of the catastrophizing data showed that the effect of catastrophizing about pain during the lifting task on the cognitive distraction task was mediated by the amount of attention paid to pain. Clinical implications of these findings are discussed.

Activities of Daily Living↗
PubMed2004

The anticipation of pain modulates spatial attention: evidence for pain-specificity in high-pain catastrophizers.

Recent studies have suggested that the anticipation of pain may modulate spatial attention. However, it is possible that this modulation reflects a general effect of anticipating somatosensory stimulation, without being pain-specific. In the present study, we therefore compared the effect of the anticipation of somatosensory stimulation on spatial attention between two groups, using conditioned signals in a spatial cueing paradigm. In the pain group, signals predicted painful electrocutaneous stimulation, whereas in the control group, signals predicted non-painful vibrotactile stimulation. Tests between both groups showed that attentional engagement was equally facilitated by the anticipation of somatosensory stimulation in both groups. Interestingly, disengagement of attention was more retarded by the anticipation of pain than by the anticipation of non-painful vibrotactile stimulation in participants high in catastrophic thinking about pain. Theoretical and clinical implications of these findings are discussed.

Adolescent↗
PubMed2004

Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities.

This paper investigates whether acceptance was related to less attention to pain, and to more engagement with daily activities. The results of two studies are reported. In a first cross-sectional study, 501 chronic pain patients completed self-report instruments on pain severity, attention to pain and acceptance. In a second diary study, 62 patients with chronic pain reported pain intensity, attention to pain and characteristics of goal-directed behaviour 8 times a day using an experience sampling method. Acceptance was measured using a self-report instrument. It was found that acceptance was related to less attention to pain (study 1 and study 2), more engagement with daily activities, a higher motivation to complete activities and a better efficacy to perform daily activities (study 2). Results are discussed in terms of how a positive life despite pain may be preserved by a flexible adjustment of personal goals to current limitations and adversities.

Activities of Daily Living↗
PubMed2003

Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal.

This paper reports upon: (1) the value of acceptance of pain in predicting well-being in patients suffering from chronic pain and (2) the construct validity of acceptance by comparing two questionnaires designed to measure acceptance (the Chronic Pain Acceptance Questionnaire, CPAQ, unpublished doctoral dissertation, University of Nevada, Reno, NV, 1992 and the Illness Cognitions Questionnaire, ICQ, J Consult Clin Psychol 69 (2001) 1026). The results of two independent cross-sectional studies are reported. Study 1 included 120 patients seeking help in tertiary care settings. In Study 2, 66 patients were recruited from a self-support group for fibromyalgia patients and from a pain clinic. Both studies revealed that acceptance of pain predicted mental well-being beyond pain severity and pain catastrophizing, but did not account for physical functioning. In both instruments, it was found that acceptance of pain was strongly related to engagement in normal life activities and the recognition that pain may not change. Acceptance in both instruments was strongly related to a cognitive control over pain. Study 2 further revealed that the correlation between the CPAQ and the ICQ is moderate, indicating that both instruments measured different aspects of acceptance. It is concluded that acceptance of chronic pain is best conceived of as the shift away from pain to non-pain aspects of life, and the shift away from a search for a cure with an acknowledgement that pain may not change.

Adaptation, Psychological↗
PubMed2003

Ketamine as adjuvant to opioids for cancer pain. A qualitative systematic review.

Ketamine is increasingly being used as an adjuvant to opioids in the treatment of refractory cancer pain. This systematic review examines the available evidence. Randomized, controlled trials, with or without crossover, were included. Studies were identified from MEDLINE, EMBASE, CANCERLIT, the Cochrane Library, handsearched reference lists from review articles and chapters from standard textbooks on pain and palliative care and reference lists from papers retrieved. Four randomized, controlled studies were identified. Two were excluded due to poor quality. Both included studies concluded that ketamine improves morphine treatment in cancer pain. Quantitative meta-analysis was not possible. The available evidence is not sufficient to conclude that ketamine improves the effectiveness of opioid treatment in cancer pain. High quality, randomized, controlled trials with larger numbers of patients and standardized, clinically relevant routes of administration of ketamine are needed.

Analgesics↗
PubMed2002

Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief.

A systematic review and subset meta-analysis of published randomised controlled trials of psychological therapies for children and adolescents with chronic pain is reported. A search of four computerised abstracting services recovered 123 papers from which 28 potential trials were identified. Eighteen met the criteria for inclusion in the review. The majority of these papers reported brief behavioural and cognitive behavioural interventions for children with headache and many were conducted in community (i.e. school) settings. Meta-analysis was applicable for 12 headache trials and one trial of recurrent abdominal pain using the Pain Index. The odds-ratio for a 50% reduction in pain was 9.62 and the number needed to treat was 2.32, indicating that the psychological treatments examined are effective in reducing the pain of headache. The quality of the 18 trials retrieved is narratively reviewed and suggestions for the development of trials in this field are made.

Abdominal Pain↗