The purpose of this meta-analytic review was to quantify the effects of psychological therapies for the management of chronic pain in youth. Specifically, in this review we updated previous ...systematic reviews of randomized controlled trials by including new trials, and by adding disability and emotional functioning to pain as treatment outcomes. Electronic searches of the Cochrane Register of Randomised Controlled Trials, MEDLINE, PsycLIT, EMBASE, and the Social Sciences Citation Index were conducted from inception through August 2008. Methodological quality of the studies was assessed, and data extracted on the three primary outcomes of interest. Twenty-five trials including 1247 young people met inclusion criteria and were included in the meta-analysis. Meta-analytic findings demonstrated a large positive effect of psychological intervention on pain reduction at immediate post-treatment and follow-up in youth with headache, abdominal pain, and fibromyalgia. Small and non-significant effects were found for improvements in disability and emotional functioning, although there were limited data on these outcomes available in the included studies. Omnibus cognitive–behavioral therapy, relaxation therapy, and biofeedback all produced significant and positive effects on pain reduction. Studies directly comparing the effects of self-administered versus therapist-administered interventions found similar effects on pain reduction. Psychological therapies result in improvement in pain relief across several different pain conditions in children. Future trials are needed that incorporate non-pain outcome domains, that focus significant therapeutic content on reductions in disability, and that include extended follow-up to better understand maintenance of treatment effects.
EAU Guidelines on Chronic Pelvic Pain Fall, Magnus; Baranowski, Andrew P; Elneil, Sohier ...
European urology,
01/2010, Letnik:
57, Številka:
1
Journal Article
Recenzirano
Abstract Context These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to ...incorporate the recommendations into their clinical practice. Objective To revise guidelines for the diagnosis, therapy, and follow-up of CPP patients. Evidence acquisition Guidelines were compiled by a working group and based on a systematic review of current literature using the PubMed database, with important papers reviewed for the 2003 EAU guidelines as a background. A panel of experts weighted the references. Evidence synthesis The full text of the guidelines is available through the EAU Central Office and the EAU Web site ( www.uroweb.org ). This article is a short version of the full guidelines text and summarises the main conclusions from the guidelines on the management of CPP. Conclusions A guidelines text is presented including chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecologic practice, neurogenic dysfunctions, the role of the pelvic floor and pudendal nerve, psychological factors, general treatment of CPP, nerve blocks, and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from CPP.
Pain-related emotions are a major barrier to effective self rehabilitation in chronic pain. Automated coaching systems capable of detecting these emotions are a potential solution. This paper lays ...the foundation for the development of such systems by making three contributions. First, through literature reviews, an overview of how pain is expressed in chronic pain and the motivation for detecting it in physical rehabilitation is provided. Second, a fully labelled multimodal dataset (named `EmoPain') containing high resolution multiple-view face videos, head mounted and room audio signals, full body 3D motion capture and electromyographic signals from back muscles is supplied. Natural unconstrained pain related facial expressions and body movement behaviours were elicited from people with chronic pain carrying out physical exercises. Both instructed and non-instructed exercises were considered to reflect traditional scenarios of physiotherapist directed therapy and home-based self-directed therapy. Two sets of labels were assigned: level of pain from facial expressions annotated by eight raters and the occurrence of six pain-related body behaviours segmented by four experts. Third, through exploratory experiments grounded in the data, the factors and challenges in the automated recognition of such expressions and behaviour are described, the paper concludes by discussing potential avenues in the context of these findings also highlighting differences for the two exercise scenarios addressed.
We present a detailed framework for understanding the numerous and complicated interactions among psychological and social determinants of pain through examination of the process of pain ...communication. The focus is on an improved understanding of immediate dyadic transactions during painful events in the context of broader social phenomena. Fine-grain consideration of social transactions during pain leads to an appreciation of sociobehavioral events affecting both suffering persons as well as caregivers. Our examination considers knowledge from a variety of perspectives, including clinical health psychology, social and developmental processes, evolutionary psychology, communication studies, and behavioral neuroscience.
Across the globe, from mega-cities to isolated resource enclaves, the provision and governance of security takes place within assemblages that are de-territorialized in terms of actors, technologies, ...norms and discourses. They are embedded in a complex transnational architecture, defying conventional distinctions between public and private, global and local. Drawing on theories of globalization and late modernity, along with insights from criminology, political science and sociology, Security Beyond the State maps the emergence of the global private security sector and develops a novel analytical framework for understanding these global security assemblages. Through in-depth examinations of four African countries – Kenya, Nigeria, Sierra Leone and South Africa – it demonstrates how global security assemblages affect the distribution of social power, the dynamics of state stability, and the operations of the international political economy, with significant implications for who gets secured and how in a global era.
Abstract
Objective
To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy.
Design
Systematic ...review.
Methods
Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20–0.49), medium (0.50–0.79), or large (≥0.80).
Results
We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate.
Conclusions
In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.
Torture and other forms of ill treatment have been reported in at least 141 countries, exposing a global crisis. Survivors face multiple physical, psychological, and social difficulties. ...Psychological consequences for survivors are varied, and evidence on treatment is mixed. We conducted a systematic review and meta-analysis to estimate the benefits and harms of psychological, social, and welfare interventions for torture survivors.
We updated a 2014 review with published randomised controlled trials (RCTs) for adult survivors of torture comparing any psychological, social, or welfare intervention against treatment as usual or active control from 1 January 2014 through 22 June 2019. Primary outcome was post-traumatic stress disorder (PTSD) symptoms or caseness, and secondary outcomes were depression symptoms, functioning, quality of life, and adverse effects, after treatment and at follow-up of at least 3 months. Standardised mean differences (SMDs) and odds ratios were estimated using meta-analysis with random effects. The Cochrane tool was used to derive risk of bias. Fifteen RCTs were included, with data from 1,373 participants (589 females and 784 males) in 10 countries (7 trials in Europe, 5 in Asia, and 3 in Africa). No trials of social or welfare interventions were found. Compared to mostly inactive (waiting list) controls, psychological interventions reduced PTSD symptoms by the end of treatment (SMD -0.31, 95% confidence interval CI -0.52 to -0.09, p = 0.005), but PTSD symptoms at follow-up were not significantly reduced (SMD -0.34, 95% CI -0.74 to 0.06, p = 0.09). No significant improvement was found for PTSD caseness at the end of treatment, and there was possible worsening at follow-up from one study (n = 28). Interventions showed no benefits for depression symptoms at end of treatment (SMD -0.23, 95% CI -0.50 to 0.03, p = 0.09) or follow-up (SMD -0.23, 95% CI -0.70 to 0.24, p = 0.34). A significant improvement in functioning for psychological interventions compared to control was found at end of treatment (SMD -0.38, 95% CI -0.58 to -0.18, p = 0.0002) but not at follow-up from only one study. No significant improvement emerged for quality of life at end of treatment (SMD 0.38, 95% CI -0.28 to 1.05, p = 0.26) with no data available at follow-up. The main study limitations were the difficulty in this field of being certain of capturing all eligible studies, the lack of modelling of maintenance of treatment gains, and the low precision of most SMDs making findings liable to change with the addition of further studies as they are published.
Our findings show evidence that psychological interventions improve PTSD symptoms and functioning at the end of treatment, but it is unknown whether this is maintained at follow-up, with a possible worsening of PTSD caseness at follow-up from one study. Further interventions in this population should address broader psychological needs beyond PTSD while taking into account the effect of multiple daily stressors. Additional studies, including social and welfare interventions, will improve precision of estimates of effect, particularly over the longer term.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Chronic non‐cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on ...people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012.
Objectives
To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU).
Search methods
We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials.
Selection criteria
RCTs of psychological treatments compared with active control or TAU of face‐to‐face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end.
Data collection and analysis
Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow‐up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment.
Main results
We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies.
CBT
The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) ‐0.09, 95% confidence interval (CI) ‐0.17 to ‐0.01; 3235 participants; 23 studies; moderate‐quality evidence), disability (SMD ‐0.12, 95% CI ‐0.20 to ‐0.04; 2543 participants; 19 studies; moderate‐quality evidence), and distress (SMD ‐0.09, 95% CI ‐0.18 to ‐0.00; 3297 participants; 24 studies; moderate‐quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD ‐0.22, 95% CI ‐0.33 to ‐0.10; 2572 participants; 29 studies; moderate‐quality evidence), disability (SMD ‐0.32, 95% CI ‐0.45 to ‐0.19; 2524 participants; 28 studies; low‐quality evidence), and distress (SMD ‐0.34, 95% CI ‐0.44 to ‐0.24; 2559 participants; 27 studies; moderate‐quality evidence). Effects were largely maintained at follow‐up for CBT versus TAU, but not for CBT versus active control.
Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons.
BT
We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD ‐0.67, 95% CI ‐2.54 to 1.20, very low‐quality evidence; disability SMD ‐0.65, 95% CI ‐1.85 to 0.54, very low‐quality evidence; or distress SMD ‐0.73, 95% CI ‐1.47 to 0.01, very low‐quality evidence). At follow‐up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD ‐0.08, 95% CI ‐0.33 to 0.17, low‐quality evidence; disability SMD ‐0.02, 95% CI ‐0.24 to 0.19, moderate‐quality evidence; distress SMD 0.22, 95% CI ‐0.10 to 0.54, low‐quality evidence) at treatment end. At follow‐up, we found one to three studies with no evidence of difference between BT and TAU.
We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs.
ACT
We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD ‐0.25, 95% CI ‐0.63 to 0.12, very low‐quality evidence), disability (SMD ‐0.67, 95% CI ‐1.56 to 0.22, very low‐quality evidence) or distress (SMD ‐0.30, 95% CI ‐0.70 to 0.10, very low‐quality evidence) at treatment end. At follow‐up, there was no evidence of effect for pain or distress (both very low‐quality evidence), but two studies showed a large benefit for reducing disability (SMD ‐1.22, 95% CI ‐2.28 to ‐0.17, very low‐quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD ‐0.83, 95% CI ‐1.57 to ‐0.09, very low‐quality evidence), but none for disability (SMD ‐1.39, 95% CI ‐3.20 to 0.41, very low‐quality evidence), or distress (SMD ‐1.16, 95% CI ‐2.51 to 0.20, very low‐quality evidence). Lack of data precluded analysis at follow‐up.
We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low‐quality evidence because the estimates are uncertain and could be easily overturned.
Authors' conclusions
We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.
We introduce a generative model of part‐segmented 3D objects: the shape variational auto‐encoder (ShapeVAE). The ShapeVAE describes a joint distribution over the existence of object parts, the ...locations of a dense set of surface points, and over surface normals associated with these points. Our model makes use of a deep encoder‐decoder architecture that leverages the part‐decomposability of 3D objects to embed high‐dimensional shape representations and sample novel instances. Given an input collection of part‐segmented objects with dense point correspondences the ShapeVAE is capable of synthesizing novel, realistic shapes, and by performing conditional inference enables imputation of missing parts or surface normals. In addition, by generating both points and surface normals, our model allows for the use of powerful surface‐reconstruction methods for mesh synthesis. We provide a quantitative evaluation of the ShapeVAE on shape‐completion and test‐set log‐likelihood tasks and demonstrate that the model performs favourably against strong baselines. We demonstrate qualitatively that the ShapeVAE produces plausible shape samples, and that it captures a semantically meaningful shape‐embedding. In addition we show that the ShapeVAE facilitates mesh reconstruction by sampling consistent surface normals.
Summary
Background
Anti‐tumour necrosis factor‐α (TNFα) antibodies are efficacious in inflammatory bowel disease (IBD). These drugs carry the theoretical risk of malignancy, particularly lymphoma, ...but no systematic review and meta‐analysis has examined this issue.
Aim
To pool data from all available placebo‐controlled studies to estimate risk of malignancy with anti‐TNFα therapy in IBD.
Methods
MEDLINE, EMBASE and the Cochrane central register of controlled trials were searched to November 2013. Randomised controlled trials (RCTs) comparing anti‐TNFα therapy with placebo in adults with Crohn's disease (CD) or ulcerative colitis (UC) were eligible. Data were pooled to obtain a relative risk (RR) of malignancy with a 95% confidence interval (CI).
Results
The search strategy identified 25 338 citations, of which 22 RCTs were eligible (11 infliximab, six adalimumab, four certolizumab and one golimumab) involving 7054 patients (4566 CD and 2488 UC). In total, there were 16 (0.39%) malignancies in 4135 IBD patients allocated to anti‐TNFα, compared with 13 (0.45%) in 2919 patients randomised to placebo. There were no cases of lymphoma in the active treatment group, compared with three (0.1%) in the control group. The RR of malignancy for patients receiving anti‐TNFα therapy compared with placebo was 0.77 (95% CI 0.37–1.59). When seven individuals with nonmelanoma skin cancer were excluded from the analysis, the RR was 0.90 (95% CI 0.40–2.02).
Conclusions
Anti‐TNFα therapy was not associated with an increased risk of malignancy in patients with IBD. However, no trials provided data for risk of malignancy beyond 1 year of treatment, meaning that an increased risk in the longer term cannot be excluded.
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