Behavioral assessment and treatment of chronic pain: current status and future directions.
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Behavior Therapy↗
Biomedical subjects
F J Keefe
Publications and source records attributed to F J Keefe.
Collagen vascular disease: can behavior therapy help?
This study examined the efficacy of a simple autogenic and biofeedback treatment package in the management of Raynaud's Phenomenon secondary to diagnosed collagen vascular disease. The patient, diagnosed as suffering from mixed connective tissue disease, had an average of 6.3 vasospastic attacks per day during a 2 week baseline period. The frequency of daily attacks dropped to 4.2 after 10 weeks and 2.5 attacks after 1 yr of training. In addition, the patient displayed a gradual improvement in the ability to maintain digital skin temperature in the presence of ambient cold stress.
Autogenic Training↗
Biofeedback, autogenic training, and progressive relaxation in the treatment of Raynaud's disease: a comparative study.
Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26 degrees to 17 degrees C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.
Autogenic Training↗
A 1-year follow-up of Raynaud's patients treated with behavioral therapy techniques.
The purpose of this study was to assess to what degree learned control of digital temperature and vasospastic attacks can be retained by Raynaud's patients over a full year period. Subjects were 19 patients suffering from diagnosed idiopathic Raynaud's disease who had undergone behavioral training. These patients had been trained to increase digital temperature using either autogenic training, biofeedback, or a combination of autogenic training and temperature biofeedback. Results indicated that the mean number of vasospastic attacks per day occurring 1 year after training was approximately equal to the number occurring at the end of the initial training (1.2-1.3 per day). Patient satisfaction with the treatment program was above average (3.5 on a 5-point scale). The patients' ability to maintain digital temperature during the cold stress challenge was imparied, however. At 1-year follow-up, digital temperature readings taken in the laboratory were identical to baseline levels.
Adult↗
Responsive parenting: an approach to training parents of problem children.
Two behavior modification groups for parents of problem children between the ages of two and ten were conducted along the lines of the Responsive Teaching Model. The two groups met for 10 and 8 weeks, respectively, with six families represented in each group. In Responsive Parenting (RP), parents are taught to observe and measure their children's problematic behavior. Subsequently, each parent develops a home project designed to modify this behavior; 11 of the 12 parents developed a successful home project. In addition, the attendance was approximately 90% and the completion of weekly assignments was close to 100%. Paper-and-pencil measures revealed that the parents were very satisfied with the parent-training group and rated their children as improved on a bipolar adjective checklist. These results are discussed with regard to implications for the delivery of mental health services for children. Future research directions are delineated.
Adult↗
Electromyographic biofeedback: behavioral treatment of neuromuscular disorders.
Electromyographic biofeedback is becoming widely used to help patients regain voluntary control of specific muscles affected by neuromuscular disorders. Electromyographic feedback training has been employed in the rehabilitation of patients affected by poliomyelitis, cerebrovascular accident, torticollis, nerve injury, temporomandibular joint syndrome, bruxism, and other disorders. While EMG biofeedback appears to be a promising treatment technique, the research literature on its effectiveness consists mainly of uncontrolled case reports and clinical trials. It is concluded that new studies with more sophisticated design and more careful control are needed to demonstrate that EMG biofeedback makes a unique contribution to the treatment of neuromuscular disorders. Research is needed to identify relevant patients characteristics predictive of success, specify appropriate muscle groups for the treatment of particular disorders, determine how feedback can be most efficiently combined with more conventional techniques in achieving a therapeutic effect, and establish meaningful criteria of success in the treatment of neuromuscular disorders.
Behavior Therapy↗
Biofeedback vs. instructional control of skin temperature.
The purpose of this study was twofold: (1) to determine the effects of instructions vs. biofeedback on the development of skin temperature self-control and (2) to assess how well learned control over temperature can be retained over time. Sixty female subjects were assigned to one of six groups: (1) response-specific instructions plus feedback, (2) thermal suggestions plus feedback, (3) instructions to rest plus feedback, (4) response-specific instructions without feedback, (5) thermal suggestions without feedback, and (6) instructions to rest without feedback. All subjects participated in five training sessions on 5 consecutive days and two follow-up sessions spaced 1 week and 2 weeks after training. Subjects given either feedback and response-specific instructions, feedback and thermal suggestions, or no feedback and thermal suggestions were able to produce significant increases in digital skin temperature consistently after three training sessions. Subjects in these groups retained the ability to control skin temperature both 1 and 2 weeks after training. Subjects in the remaining conditions showed no evidence of learned control over skin temperature.
Adolescent↗
The measurement of human penile tumescence.
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Male↗
Conditioning changes in differential skin temperature.
8 male Ss were presented with visual and auditory analog feedback regarding the difference between forehead and finger temperature. 4 Ss were instructed to raise the temperature of their finger in comparison with the forehead, while a second group of 4 Ss was instructed to lower the temperature of their finger in comparison with the temperature of the forehead. After 12 15-min. training sessions all Ss were able to produce changes in differential skin temperature in the specified direction. Differential changes in skin temperature correlated highly with changes in absolute finger temperature. These results are discussed as relevant to the clinical application of skin temperature control.
Adolescent↗
Pain in the head and neck cancer patient: changes over treatment.
The incidence, severity, and location of pain was evaluated in 30 head and neck cancer patients prior to treatment after the first phase of their treatment and upon the completion of treatment. The incidence of pain was relatively high (40%-70%) and tended to increase slightly over treatment. Patients having advanced disease (stage III or IV) had a higher incidence of pain. Pain severity ratings were stable over treatment. Pain was located close to tumor or incision sites, and a trend for patients to report a greater number of pain sites over treatment was noted. While medical status variables (disease stage and site) were found to predict pain status after the initial phase of cancer treatment, initial pain measurements were more likely to predict pain status at the completion of treatment.
Carcinoma, Squamous Cell↗
The control group dilemma in clinical research: applications for psychosocial and behavioral medicine trials.
OBJECTIVE: Clinical research on psychosocial and behavioral medicine interventions has burgeoned in the past two decades, so much so that sole reliance on standard no-treatment control conditions may no longer be appropriate or feasible. We discuss the ethical, theoretical, scientific, and statistical considerations that shape current clinical outcomes research for psychosocial and behavioral medicine interventions. METHOD AND RESULTS: Secondary analysis of a psychosocial randomized trial (N = 127) illustrates some of these points. CONCLUSIONS: A new design for randomized clinical trials is described that does not require a no-treatment control group, and that reveals dose-response relationships between interventions and treatment outcomes.
Behavior Therapy↗
Predicting peak oxygen uptake among older patients with chronic illness.
PURPOSE: To compare three equations developed to predict VO2 among patients diagnosed with one of two chronic diseases: essential hypertension (HTN), and fibromyalgia (FM). The equations included the American College of Sports Medicine (ACSM) equation, the FAST equation developed from the Fitness and Arthritis in Seniors Trial (FAST), and an equation developed by Foster et al. METHODS: One hundred twenty-two HTN subjects and 68 FM subjects completed a maximum exercise test according to the Duke/Wake Forest protocol. Measured peak VO2 was then compared with the VO2 predicted by the ACSM, FAST and FOSTER equations, using several statistical methods. RESULTS: The ACSM equation overpredicted peak VO2 in the HTN group by 10.0 +/- 4.0 mL/kg-1/min-1, and in the FM group by 8.6 +/- 4.9 mL/kg-1/min-1 (P < 0.0001). The FAST equation, however, underestimated peak VO2 by 1.5 +/- 4.2 mL/kg-1/min-1 (P < 0.01) and 1.0 +/- 3.3 mL/kg-1/min-1 (P < 0.0001) in the HTN and FM groups, respectively. The FOSTER equation overestimated peak VO2 by 2.3 +/- 3.6 mL/kg-1/min-1 in the HTN group and by 2.1 +/- 3.5 mL/kg-1/min-1 in the FM group (P < 0.0001). A large degree of variability was found for each of the equations. CONCLUSION: Results of this investigation indicate that all three equations produced peak VO2 values that were statistically different from measured values. Although the ACSM equation overestimated VO2 by more than 2 metabolic equivalents (METs) in each patient group, both the FAST and FOSTER equations produced differences that were less than 1 MET. Further research is needed to examine the FAST and FOSTER equations among other patient populations and with other exercise protocols.
Adult↗
Behavioral assessment of chronic orofacial pain.
Orofacial pain is usually evaluated and treated from a biomedical perspective. There is no question that the large majority of individuals having acute orofacial pain benefit from timely and appropriate medical intervention. When orofacial pain persists, however, the likelihood that this pain can influence and be influenced by behavioral factors increases. While some individuals are able to adapt and cope with chronic orofacial pain, others develop significant behavioral problems. These problems may include an overly sedentary lifestyle, dependence on habit-forming narcotic medications, or severe depression or anxiety. The hallmark of the behavioral perspective on chronic pain is the insistence that a careful assessment and treatment of such behavioral problems is just as important as appropriate biomedical intervention.(1)
Chronic Disease↗