Prediction of treatment response in pain patients: the illness self-concept repertory grid and EMG feedback

Eighteen patients with chronic musculoskeletal pain completed a trial of EMG feedback where each subject was exposed to biofeedback, a control condition and a waiting list. Pain scores were determined pre- and posttrial, and the percentage change calculated for each subject. EMG activity and present pain measured during the trial gave an EMG/pain correlation for each patient. A repertory grid was completed by each patient at the pretrial evaluation. Repertory grid technique is a highly flexible way of measuring subjective data such as attitudes. The specific test used involved the patient in rating a series of 6 self-concepts across 8 'constructs' or concepts concerning illness and emotional distress. The resulting matrix of 48 ratings was analysed to produce a measurement of 'distance' between the self and ideal-self concepts. The major finding was that the self-ideal-self distance was significantly positively correlated with pain score changes by rank correlation. The self-ideal-self distance is essentially a measure of self-satisfaction or dissatisfaction and the results imply that patients who show a relatively greater degree of self-dissatisfaction are more likely to respond well to EMG feedback. In addition, patients with high EMG/pain correlations had a better outcome and this measure also correlated with pain scores. The relationship between self-concepts and EMG/pain correlations is discussed. The Illness Self-Concept Repertory Grid appears capable of predicting treatment outcome and shows promise as a prognostic tool.     

Myofascial pain of the temporomandibular joint: A review of the behavioral-relaxation therapies

This paper reviews the behavioral-relaxation treatments of myofascial pain-dysfunction syndrome. The evidence indicates that this pain (located around the oral cavity) is due to muscle hyperactivity, most commonly of the lateral pterygoids. Research concerning relaxation techniques (i.e. progressive muscle relaxation and electromyographic feedback) has indicated the following: (a) in analogue research, normal healthy controls can learn to relax their muscles of mastication profoundly even during stress, and (b) in case reports, relaxation treatments are helpful clinical interventions, especially for pain patients who are not depressed, and who have not had the pain for more than a few years. Well controlled research is the next, essential step.     

Acupuncture and chronic pain mechanisms: the moderating effects of affect, personality, and stress on response to treatment.

The present study, part of a larger project investigating neurophysiological and psychosocial factors affecting response to acupuncture for chronic pain, compares responders and non-responders to acupuncture on a series of variables assessing personality, affect and stress. Subjects were 40 patients with pain beneath the waist level longer than 6 months duration selected from the roles of the Multidisciplinary Pain Clinic. Responders, defined as 50% or more reduction in pain estimate for greater than two weeks, were found to be less depressed, less passive and overly conventional, have shorter duration of pain, endorse less frequent exposure to stressors, and have less serious non pain-related illnesses. The findings are viewed as linking the intractability of pain states with psychosocial factors which may interfere with response to somatic modes of therapy or which may interfere via alterations of tonic neurohumoral factors. The study also in seen as supporting the importance of considering psychological variables in evaluating patients for pain treatment strategies and suggests inclusion of such variables in investigating response to other modalities of treatment for chronic pain.     

Essential human resources for antimicrobial stewardship teams in Japan: Estimates from a nationwide survey conducted by the Japanese Society of Chemotherapy

Implementation of antimicrobial stewardship programs (ASPs) with multidisciplinary antimicrobial stewardship teams (ASTs) is critical for appropriate antimicrobial use at healthcare facilities. Although the Japanese medical reimbursement system was revised to allow fees for ASP implementation, several concerns remain, including understaffing and enforcement of the recommendations on ASTs and ASPs in practice. Furthermore, there are no recommendations on full-time equivalents (FTEs) of the core members in ASTs in Japan. This committee report presents our recommendations on ASTs based on an analysis of the nationwide survey on implemented ASPs and staff FTEs at 1358 healthcare facilities conducted by the Japanese Society of Chemotherapy. Our report provides a directive for structural and financial support of ASTs and should aid in planning for the enhancement of AST practices and the organization of new ASTs.