Fibromyalgia: Nielson WR

Harth M, Nielson WR. · No affiliation provided · J Rheumatol. · Pubmed #17477475 links to  free full text

This publication has no abstract.

Nielson WR, Harth M. · No affiliation provided · J Rheumatol. · Pubmed #15088282 links to  free full text

This publication has no abstract.

Nielson WR, Weir R. · Department of Medicine, University of Western Ontario, London, Canada. · Clin J Pain. · Pubmed #11783824 No free full text.

Abstract: BACKGROUND: Biopsychosocial treatments address the range of physical, psychological, and social components of chronic pain. OBJECTIVE: This review sought to determine how effective unimodal and multimodal biopsychosocial approaches are in the treatment of chronic pain. METHODOLOGY: The literature search identified three systematic reviews of the literature and 21 randomized controlled trials to provide the evidence for this review. RESULTS: The systematic reviews and 12 randomized controlled trials reported on chronic low back pain. Other randomized controlled trials studied fibromyalgia (three trials) and back or other musculoskeletal disorders (five trials). Biopsychosocial components reviewed were electromyogram feedback and hypnosis as unimodal approaches, and behavioral and cognitive-behavioral treatments and back school, or group education, as multimodal approaches for chronic low back pain. For other chronic pain disorders, cognitive-behavioral treatments were reviewed. Comparisons were hindered by studies with heterogeneous subjects, varied comparison groups, different cointerventions and follow-up times, variable outcomes, and a range of analytic methods. CONCLUSIONS: Multimodal biopsychosocial treatments that include cognitive-behavioral and/or behavioral components are effective for chronic low back pain and other musculoskeletal pain for up to 12 months (level 2). There is limited evidence (level 3) that electromyogram feedback is effective for chronic low back pain for up to 3 months. The remaining evidence of longer-term effectiveness and of effectiveness of other interventions was inadequate (level 4a) or contradictory (level 4b). Future studies of cognitive-behavioral treatments should be condition specific, rather than include patients with different pain conditions.

Nielson WR, Merskey H. · Arthritis Institute, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada. · Curr Pain Headache Rep. · Pubmed #11403736 No free full text.

Abstract: The view that fibromyalgia syndrome (FMS) is a psychiatric disorder or can be caused by stress or abuse is unproven. The construct of posttraumatic FMS has not been adequately validated. Similarly, there is no evidence that communicating the diagnosis to patients causes iatrogenic consequences. Research suggesting a higher rate of posttraumatic stress disorder among those with FMS is weak. More research examining specific psychological processes in FMS is desirable. Because of the potential for harm to patients, clinicians should be cognizant of possible undue influences on medical opinion by agencies providing health care and research funding.

Shupak NM, McKay JC, Nielson WR, Rollman GB, Prato FS, Thomas AW. · Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario N6A 4V2. · Pain Res Manag. · Pubmed #16770449 links to  free full text

Abstract: BACKGROUND: Specific pulsed electromagnetic fields (PEMFs) have been shown to induce analgesia (antinociception) in snails, rodents and healthy human volunteers. OBJECTIVE: The effect of specific PEMF exposure on pain and anxiety ratings was investigated in two patient populations. DESIGN: A double-blind, randomized, placebo-controlled parallel design was used. METHOD: The present study investigated the effects of an acute 30 min magnetic field exposure (less than or equal to 400 microTpk; less than 3 kHz) on pain (McGill Pain Questionnaire [MPQ], visual analogue scale [VAS]) and anxiety (VAS) ratings in female rheumatoid arthritis (RA) (n=13; mean age 52 years) and fibromyalgia (FM) patients (n=18; mean age 51 years) who received either the PEMF or sham exposure treatment. RESULTS: A repeated measures analysis revealed a significant pre-post-testing by condition interaction for the MPQ Pain Rating Index total for the RA patients, F(1,11)=5.09, P<0.05, estimate of effect size = 0.32, power = 0.54. A significant pre-post-effect for the same variable was present for the FM patients, F(1,15)=16.2, P<0.01, estimate of effect size = 0.52, power =0.96. Similar findings were found for MPQ subcomponents and the VAS (pain). There was no significant reduction in VAS anxiety ratings pre- to post-exposure for either the RA or FM patients. CONCLUSION: These findings provide some initial support for the use of PEMF exposure in reducing pain in chronic pain populations and warrants continued investigation into the use of PEMF exposure for short-term pain relief.

Nielson WR, Jensen MP, Hill ML. · Department of Medicine, Division of Rheumatology, University of Western Ontario, ON, London, Canada. · Pain. · Pubmed #11166466 No free full text.

Abstract: Patients with fibromyalgia syndrome (FS) experience a decreased ability to participate in both vocational and avocational activities. Although many treatment programs advocate activity pacing techniques, 'pacing' is a poorly understood concept for which there are no available measures. The present study describes a brief six-item pacing scale that can be administered as part of the Chronic Pain Coping Inventory (CPCI). Preliminary data indicate that this scale is a valid, reliable index of the pacing construct that is associated with physical impairment in patients with FS and is unrelated to simple task persistence.

Nielson WR, Jensen MP, Ehde DM, Kerns RD, Molton IR. · Department of Medicine, University of Western Ontario and the Beryl and Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care London, Ontario, Canada. · J Pain. · Pubmed #18337183 No free full text.

Abstract: This study describes further development of the Multidimensional Pain Readiness to Change Questionnaire (MPRCQ2), a measure of readiness to adopt a variety of pain management and coping strategies commonly taught in multidisciplinary treatment programs. Clinical samples were recruited from a Fibromyalgia Day Program (n = 139) and an Arthritis Day Program (n = 51) as well as 2 survey samples with pain resulting from either a spinal cord injury (n = 127) or an amputation (n = 120). The results indicate preliminary support for the reliability and validity of the MPRCQ2. The MPRCQ2 may be helpful in future research investigating the relationship between readiness to change pain-related coping and adoption of coping behaviors and adjustment to chronic pain. PERSPECTIVE: This study describes the development of a revised version of the MPRCQ, the MPRCQ2, in 4 patient samples. The results support the reliability and validity of the MPRCQ2 in individuals with fibromyalgia syndrome, arthritis, acquired amputation, and spinal cord injury and improve on some aspects of the instrument.

Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML. · Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 356490, Seattle, WA 98195-6490, USA. · Pain. · Pubmed #15327812 No free full text.

Abstract: A patient's readiness to adopt a self-management approach to pain has been hypothesized to increase during multidisciplinary pain treatment and to impact pain coping responses. The Pain Stages of Change Questionnaire (PSOCQ; [J Pain (1997) 227]) was designed to assess four components of readiness to self-manage pain: pre-contemplation, contemplation, action, and maintenance. We tested three hypotheses concerning this construct in two different samples of patients with chronic pain: (1) readiness to self-manage pain, as assessed by the PSOCQ, would increase from pre-multidisciplinary pain treatment to post-treatment and follow-up; (2) changes in readiness to self-manage pain measured pre-treatment to post-treatment and follow-up would be associated with changes in the use of pain coping strategies; and (3) increases in readiness to self-manage pain would be associated with improvement in multidisciplinary pain treatment. The findings supported all three hypotheses. We discuss the implications of the findings for understanding motivational issues in the self-management of pain.

Nielson WR, Jensen MP. · Department of Medicine (Division of Rhematolody), University of Western Ontario, London, Ont. Canada. · Pain. · Pubmed #15157683 No free full text.

Abstract: The present study utilized a sample of 198 individuals with Fibromyalgia Syndrome (FMS) to examine the association between treatment process variables (beliefs, coping strategies) and treatment outcomes (pain severity, activity level, emotional distress and life interference) related to a 4-week multidisciplinary fibromyalgia treatment program. Multiple regression analyses were utilized to evaluate these relationships pretreatment to posttreatment as well as from pretreatment to 3- and 6-month follow-ups. The results indicated that outcomes were most closely related to: (1) an increased sense of control over pain, (2) a belief that one is not necessarily disabled by FM, (3) a belief that pain is not necessarily a sign of damage, (4) decreased guarding, (5) increased use of exercise, (6) seeking support from others, (7) activity pacing and (8) use of coping self-statements. These findings are consistent with a cognitive-behavioural model of fibromyalgia, and suggest targets for therapeutic change.

Nielson WR, Jensen MP, Kerns RD. · Department of Medicine, University of Western Ontario, London, Ontario, Canada. · J Pain. · Pubmed #14622712 No free full text.

Abstract: Psychometric instruments that assess patient readiness to adopt pain management skills taught in multidisciplinary pain management programs have the potential to clarify interindividual responses to treatment. To date, however, such questionnaires have examined overall readiness to self-manage pain in general rather than readiness to adopt the various specific skills that are taught in multidisciplinary pain treatment. The present study describes the initial construction and evaluation of a Multidimensional Pain Readiness to Change Questionnaire (MPRCQ) that measures readiness to adopt adaptive and avoid maladaptive pain coping strategies. The MPRCQ was initially administered to patients with fibromyalgia syndrome (n = 93) and then to a replication sample of persons with acquired amputations and spinal cord injuries who have chronic pain (n = 88). The results provide preliminary support for the reliability and validity of this instrument. Further research is needed to clarify the construct validity of the MPRCQ and its clinical utility.

Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML. · Department of Rehabilitation Medicine, P.O. Box 356490, University of Washington School of Medicine, Seattle, WA 98195-6490, USA. · Pain. · Pubmed #12927625 No free full text.

Abstract: A patient's readiness to adopt a self-management approach to pain has been suggested as a construct that may explain differences among patients in coping, adjustment, and response to multidisciplinary pain treatment. The pain stages of change questionnaire (PSOCQ; Pain, 72 (1997) 227) was designed to assess four components of this construct. The current study tested the following two hypotheses in two different samples of persons with chronic pain. PSOCQ scales are associated with (1) coping strategies used to manage pain and (2) patient disability and depression. The findings supported the first hypothesis and provided mixed support for the second. The implications of the findings for understanding the readiness to self-manage pain construct and the validity of the PSOCQ for assessing this construct are discussed.

White KP, Nielson WR, Harth M, Ostbye T, Speechley M. · University of Western Ontario, London, Ontario, Canada. · Arthritis Rheum. · Pubmed #12115155 links to  free full text

Abstract: OBJECTIVE: To determine if assigning the label of fibromyalgia (FM) to individuals with chronic widespread pain has a significant effect on long-term health status, function, and health service utilization.METHODS: In the London Fibromyalgia Epidemiology Study, 100 individuals with FM were identified by screening 3,395 non-institutionalized adults. Only 28 of the 100 had been previously diagnosed with FM; for 72, the diagnostic label was new. All 28 with prediagnosed FM were female compared with 58 of the 72 newly diagnosed cases. In a prospective, within-group comparison, we compared previously non-labeled FM cases at study entry (prelabeling) and at 18 and 36 months followup (postlabeling) with respect to general health status, fibromyalgia-related symptoms, and all items from the Fibromyalgia Impact Questionnaire (FIQ) (including total FIQ score, and several measures of health service utilization) to see if health status, function, and health services utilization had changed, using paired t-tests. We also compared percentage reporting work disability at baseline and 18 months using Pearson's chi(2).RESULTS: Fifty-six (78%) of the original 72 newly diagnosed FM cases were available for reassessment at 18 months, and 43 (60%) at 36 months. Although physical functioning decreased slightly over time, there also was a statistically significant improvement in satisfaction with health, and newly diagnosed FM cases reported fewer symptoms and major symptoms over the long term. No other differences in clinical status or health service use occurred over time.CONCLUSION: The FM label does not have a meaningful adverse affect on clinical outcome over the long term. Further research is necessary to document the short- and long-term effect of labeling in the chronic pain patient.

White KP, Nielson WR, Harth M, Ostbye T, Speechley M. · Department of Medicine, University of Western Ontario, London, Canada. · J Rheumatol. · Pubmed #11908578 No free full text.

Abstract: OBJECTIVE: To estimate the severity of depression, anxiety, and other symptoms of psychological distress in a representative general population sample of fibromyalgia (FM) cases (FC) compared to pain controls (PC), and to identify strong correlates of depression and anxiety. METHODS: We compared the severity of depression, anxiety, and other symptoms of psychological distress between 2 representative community samples: (1) 74 confirmed FC, and (2) 48 adults with chronic widespread pain (PC) who did not meet the 1990 ACR criteria for FM. Psychological distress was measured using the Centre for Epidemiological Studies Depression (CES-D) Scale, the State-Trait Anxiety Inventory (STAI), and other measures of psychological distress from the literature. Using cutoff scores for CES-D and trait anxiety, we compared demographic and clinical characteristics in those above and below each cutoff score. Simple linear regression was performed to identify factors strongly and independently correlated with depression and trait anxiety. RESULTS: Compared to PC, FC were more symptomatic on virtually all measures of psychological distress. Similarly, individuals who scored above cutoff scores for depression and anxiety had more physical symptoms and had poorer function than those below. Depression and trait anxiety were highly correlated (r = 0.86). In a simple regression model, the best predictors for both depression and trait anxiety were the total number of symptoms and a physical disability score. CONCLUSION: Depression and anxiety are common and frequently severe even among community cases of FM.

Jensen MP, Nielson WR, Romano JM, Hill ML, Turner JA. · Department of Rehabilitation Medicine, Box 356490, University of Washington School of Medicine, Seattle, WA 98195-6490, USA. · Pain. · Pubmed #10812255 No free full text.

Abstract: Patient readiness to adopt new beliefs and coping responses to pain may predict response to multidisciplinary or cognitive-behavioral pain treatments that emphasize changes in beliefs and coping behaviors. According to the transtheoretical model of change, individuals go through specific stages in the process of changing maladaptive behaviors. Based on this model, Kerns et al. (1997) (Kerns RD, Rosenberg R, Jamison RN, Caudill MA, Haythornthwaite J. Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain 1997;72:227-234) developed a measure of readiness to adopt a self-management approach to pain problems (the Pain Stages of Change Questionnaire; PSOCQ) and provided preliminary data supporting the validity of the measure. The current study sought to further evaluate the PSOCQ by determining the generalizability of these preliminary findings and the ability of the PSOCQ to classify persons with chronic pain into specific stages of readiness to self-manage pain. One hundred ten patients with diverse chronic pain problems, and 119 patients with fibromyalgia completed the PSOCQ and two measures of pain-related beliefs and coping prior to entry into two separate multidisciplinary pain programs. The internal consistency and concurrent validity of the PSOCQ subscales were largely replicated, supporting the validity of the subscales as measures of readiness to self-manage pain. However, the PSOCQ demonstrated less utility as a tool for classifying individuals into one of four specific stages of readiness to adopt a self-management approach. This result may be due to the classification procedure used in the current study, the characteristics of the samples in the study, specific limitations of the measure, and/or limitations in the applicability of the transtheoretical model of change to patients with chronic pain.

Grace GM, Nielson WR, Hopkins M, Berg MA. · London Health Sciences Centre, Psychological Services and Clinical Neurological Sciences, Ontario, Canada. · J Clin Exp Neuropsychol. · Pubmed #10550807 No free full text.

Abstract: The present study compared 30 patients with Fibromyalgia Syndrome (FS) to 30 healthy control subjects matched for age, sex, and estimated intellectual level on standardized measures of attention, concentration, and memory as well as subjective ratings of memory abilities and sleep quality. In addition, in order to investigate the relationship between cognitive functioning and other physical and psychological symptoms, subjects with FS completed psychological measures of pain severity, trait anxiety, and depression. Results indicated that patients with FS performed more poorly on tests of immediate and delayed recall, and sustained auditory concentration, and their ratings of both their memory abilities and sleep quality were lower than those of controls. Furthermore, perceived memory deficits of the FS subjects were disproportionately greater than their objective deficits. Results indicated significant correlations between performance on memory and concentration measures and scores on questionnaires of pain severity and trait anxiety. Implications of these results for multidisciplinary treatment programs are discussed.