Investigating acceptance in adjustment to chronic pain: Is acceptance broader than we thought?

Research on the role of acceptance in adjustment to persisting pain has been facilitated by the development of the Chronic Pain Acceptance Questionnaire (CPAQ). However, to date the CPAQ has been used to explore acceptance of pain without taking into account the likely contribution of other cognitive variables that have been shown to influence adjustment to persisting pain. This study examined the role of pain acceptance, as measured by the CPAQ, in accounting for adjustment to pain when controlling for the effects of other cognitive variables. The results indicated that while the Activity engagement subscale of the CPAQ was predictive of depression severity, neither of the CPAQ's two subscales was predictive of pain severity or physical disability. These findings differ from some reported previously and they suggest that the CPAQ, by itself, may not be sufficient to explain the processes of acceptance of pain and, hence, adjustment to pain. The findings also indicate that the Pain willingness subscale of the CPAQ is not robust and should be discarded. A broader approach to investigating acceptance of pain is proposed.     

Coping or acceptance: what to do about chronic pain?

Research and treatment of chronic pain over the past 20 or more years have tended to focus on patient coping as the primary behavioral contribution to adjustment. The purpose of the present study was to compare a coping approach to chronic pain with a different behavioral approach referred to as acceptance of chronic pain. These approaches were compared in terms of their ability to predict distress and disability in a sample of patients seeking treatment for chronic pain. Subjects were 230 adults assessed at a university pain management center. All patients completed the coping strategies questionnaire and the chronic pain acceptance questionnaire among other standard measures. Results showed that coping variables were relatively weakly related to acceptance of pain and relatively unreliably related to pain adjustment variables. On the other hand, acceptance of chronic pain was associated with less pain, disability, depression and pain-related anxiety, higher daily uptime, and better work status. Regression analyses examined the independent contributions of coping and acceptance to key adjustment indicators in relation to chronic pain. Results from these analyses demonstrated that acceptance of pain repeatedly accounted for more variance than coping variables.     

Evolving classification systems for cancer cachexia: ready for clinical practice?

Introduction  

Involuntary weight loss, the defining factor of cachexia, is a common consequence of advanced cancer.     

A focus for nursing intervention: Realistic acceptance or helping illusions?

Despite having a life‐threatening disease, some people decide to live every remaining moment with intensity. Although they have accepted that their deaths might be imminent, they do not dwell on the possibility. They choose life and are sustained by vivid thoughts and inspirations. What can a nurse do to nourish such thoughts? Traditional theories of grief and loss maintain that one way to adjust to advanced stages of progressive disease is to accept death and prepare for it. Is it possible that these theories are simplistic and limiting in their assumptions about the way people ‘work through’ the stage of adjusting to loss? This article is a critical reflection of the process.     

Combinatorial RNAi: A Winning Strategy for the Race Against Evolving Targets?

The ability to use double-stranded RNA to inhibit gene expression sequence-specifically (RNA interference, or RNAi) is currently revolutionizing science and medicine alike. Numerous pre-clinical studies are evaluating RNAi as a novel therapeutic modality in the battle against gain-of-function autosomal dominant diseases, cancer, and viral infections. One emerging concern is that RNAi mono-therapies might ultimately fail to control viruses that can escape silencing by mutation and/or RNAi suppression. Thus, sophisticated strategies are being developed that aim to avert viral resistance by combining RNAi effectors with each other or with further gene expression inhibitors. Several reports already validate this new concept of "combinatorial RNAi" (coRNAi) and illustrate its versatility by describing co-expression of RNAi triggers directed against single or multiple, viral or cellular, targets. Other studies document the successful delivery of these triggers with additional RNA- or protein-based silencers. Moreover, vectors have been engineered to blend RNAi-mediated gene inhibition with conventional gene replacement strategies. Collectively, these efforts open up exciting new therapeutic avenues but could also augment the inherent risks of RNAi technology, including immune responses, off-targeting, and oversaturation of endogenous pathways. Here, we critically review all coRNAi strategies and discuss the requirements for their transition into clinical application.     

Evolving role of salvage reirradiation: Is global harmonization required before treatment guidelines can be developed?

Up to 90% of patients initially treated with curativeintent radiotherapy(RT) will experience locoregional failure. Historically, reirradiation(Re RT) was offered purely with palliative intent, if considered at all, due to concerns surrounding toxicity, tolerance of normal tissues, and choice of appropriate dose schedule. With technological advancements in RT delivery, coupled with longer survival in many malignancies secondary to improvements in systemic therapy, a small subset of patients presenting with localized recurrence is increasingly being offered salvage Re RT. However, this is largely on an ad hoc basis, guided mainly by small retrospective, single-institution reports. The patient population retreated, RT modality, dose received, degree of attrition and follow-up are extremely variable. The opportunity presently exists to apply lessons learned from the harmonization of the research efforts within the bone metastases community to the salvage Re RT situation: the adoption of common endpoints, minimum features to be incorporated into clinical trial design, and methods of data analysis and reporting. The Re RT data available must be harmonized so that valid, clinically applicable conclusions can be drawn. Collaboration in the form of an international registry of prospectively collected outcomes of patients reirradiated for cure for a variety of tumour sites would further support the evolution of Radiation Oncology towards personalized medicine, and away from the current "one-dose-fits-all" approach.     

General anesthesia or spinal anesthesia for hip prosthesis replacement? Studies of acceptance of both procedures by patients

Patients undergoing total hip replacement are given general anaesthesia or spinal anaesthesia. The aim of this study was to investigate the experiences of patients before, during and after general anaesthesia (68 patients) or spinal anaesthesia (77 patients). Our investigation revealed that with regard to complications (nausea and vomiting, headache and back pains), no differences between the two methods occurred. Between 25 and 30% of the patients in both groups had these complications, although there were differences between both groups regarding their concomitant diseases and medication. Patients with spinal anaesthesia had a three times higher incidence of cardiac concomitant diseases and received corresponding drugs more frequently. We found that the time of postoperative analgesia after spinal anaesthesia (210 minutes) was significantly longer than after general anaesthesia (90 minutes). The majority of the patients in both groups (approximately 90%) were satisfied with the chosen method of anaesthesia and with the postoperative pain therapy. These findings make it possible to conclude that with the exception of differences in the postoperative analgesia time, there are no differences between general anaesthesia and spinal anaesthesia regarding complications and satisfaction of the patients with both methods of anaesthesia.     

Do quality of life,anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive–behavioural therapy-based programmes

ObjectiveInterdisciplinary pain rehabilitation (IPR) usually employs a cognitive–behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes.MethodsWe used a retrospective multicentre pretest–posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions.ResultsNeither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres.ConclusionsThese findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.     

Meanings of “acceptance” for patients with long-term pain when starting rehabilitation

Purpose: The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme. Methods: Six women and three men with long-term pain were interviewed. The interviews were analysed according to interpretative phenomenological analysis. Results: The analysis revealed three different meaning structures, first: acceptance as a process of personal empowerment, “the only way forward”. Here, the individuals expressed that the body felt integrated: a trusting cooperation between self and body gave rise to hope. Second: acceptance as an equivocal project, a possible but challenging way forward. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also uncertainty and doubt about one’s ability with a body ambiguous and confusing, difficult but important to understand. Third, in acceptance as a threat and a personal failure, “no way forward” the integration of the aching body in sense of self was impossible and pain was incomprehensible, unacceptable and unfair. Pain was the cause of feeling stuck in the body, affecting the sense of self and the person’s entire life. Conclusions: The meaning of acceptance was related to acceptance of the persistency of pain, to how the individual related to the lived body and the need for changes in core aspects of self, and to the issue of whether to include others in the struggle of learning to move on with a meaningful life.

• Implications for Rehabilitation

• Healthcare professionals should be aware that individuals with long-term pain conceptualize and hold different meanings of acceptance when starting rehabilitation; this should be considered and addressed in rehabilitation programmes.

• The meaning given to acceptance is related to the experience of the lived body and the sense of self, as well as to getting legitimization/acceptance by others; therefore these aspects need to be considered during rehabilitation.

• The process of achieving acceptance seems to embrace different processes which can be understood as, and facilitated by, an embodied learning process.

• The bodily existential challenges presented in the present study, for example to develop an integrated and cooperative relationship with the painful body, can inspire health professionals to develop interventions and communication strategies focusing on the lived body. A wide range of competencies in rehabilitation clinics seems to be needed.