Multidimensional Subgroups in Migraine: Differential Treatment Outcome to a Pain Medicine Program

Davis, Philip J.; Reeves, John L.; Graff‐Radford, Steven B.; Hastie, B.; Naliboff, Bruce D.

doi:10.1046/j.1526-4637.2003.03027.x

Cited by 27 publications

(24 citation statements)

References 24 publications

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“…In agreement with previous studies [19,21,22,26,66] three patient subtypes emerged which were significantly different for pain parameters and psychological profile. Cluster I subjects on average showed the lowest symptom burden as reflected by the Pain Inventory and Zerssen’s Complaint List.…”

Section: Discussionsupporting

confidence: 92%

“…The increased use of cognitive control and the low avoidance scores may be related to the lower subjective pain stress. Thus, this subgroup resembles the type of patient referred to in literature as “uncomplicated” [19], “low impact” [26] or “good pain control” [66] with low levels of pain, impairment and dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…However, significant effects were found for general pain intensity ratings and selected pain domains. Similarly, significant reductions in pre-to-posttreatment pain were found in the “low impact” subgroup of migraine headache sufferers [26]. Thus, any craniofacial patient subtype may benefit from a self-administered relaxation training.…”

Section: Discussionmentioning

confidence: 99%

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Psychological profile and self-administered relaxation in patients with craniofacial pain: a prospective in-office study

Kirschneck¹,

Römer²,

Proff³

et al. 2013

Head Face Med

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IntroductionThe objective of this study was to evaluate the psychological profile of craniofacial pain sufferers and the impact of patient subtype classification on the short-time effectiveness of a self-administered relaxation training.MethodsOne hundred unselected in-office patients (67% females) suffering from chronic facial pain and/or headache with the presumptive diagnose of temporo-mandibular disorder (TMD) completed a questionnaire battery comprising craniofacial pain perception, somatic complaints, irrational beliefs, and pain behavior and were classified into subtypes using cluster analysis. They underwent a self-administered progressive relaxation training and were re-evaluated for pain perception after 3 months.ResultsPain was mild to moderate in the majority of patients. Symptom domains comprised parafunctional activities, temporo-mandibular pain and dysfunction, fronto-temporal headache, head/neck and neck/back pain. Three patient subtypes were identified regarding symptom/dysfunction level: (i) low burden (mild/moderate), (ii) psychosocial dysfunction (moderate/high), (iii) adaptive coping (moderate/mild). Self-rated adherence to the recommended relaxation training was moderate throughout the sample, but self-rated relief was significantly different between clusters. At follow-up, pain intensity was significantly decreased in all patients, whereas pain-related interference was improved only in dysfunctional and adaptive patients. Improvement of symptom domains varied between clusters and was most comprehensive in adaptive patients.ConclusionsIn conclusion, craniofacial pain sufferers can be divided in meaningful subtypes based on their pain perception, irrational beliefs, and pain behaviour. A self-administered relaxation training generally yielded positive effects on pain perception, however the benefit may be greater in patients with more marked symptom impact (both dysfunctional and adaptive).

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Psychological profile and self-administered relaxation in patients with craniofacial pain: a prospective in-office study

Kirschneck¹,

Römer²,

Proff³

et al. 2013

Head Face Med

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“…For example, in microarray studies of cancer, a common objective is to identify cancer subtypes that are predictive of the prognosis (survival time) of cancer patients (Bhattacharjee et al, 2001; Sorlie et al, 2001; van ’t Veer et al, 2002; Rosenwald et al, 2002; Lapointe et al, 2004; Bullinger et al, 2004). In studies of chronic pain conditions, such as fibromyalgia or temporomandibular disorders (TMD), one may wish to develop a more precise case definition for the condition of interest by identifying subgroups of patients with similar clinical characteristics (Jamison et al, 1988; Bruehl et al, 2002; Davis et al, 2003; Hastie et al, 2005). However, conventional clustering methods (such as k -means clustering and hierarchical clustering) may produce unsatisfactory results when applied to these types of problems.…”

Section: Introductionmentioning

confidence: 99%

Identification of relevant subtypes via preweighted sparse clustering

Gaynor

Bair

2017

Computational Statistics & Data Analysis

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Cluster analysis methods are used to identify homogeneous subgroups in a data set. In biomedical applications, one frequently applies cluster analysis in order to identify biologically interesting subgroups. In particular, one may wish to identify subgroups that are associated with a particular outcome of interest. Conventional clustering methods generally do not identify such subgroups, particularly when there are a large number of high-variance features in the data set. Conventional methods may identify clusters associated with these high-variance features when one wishes to obtain secondary clusters that are more interesting biologically or more strongly associated with a particular outcome of interest. A modification of sparse clustering can be used to identify such secondary clusters or clusters associated with an outcome of interest. This method correctly identifies such clusters of interest in several simulation scenarios. The method is also applied to a large prospective cohort study of temporomandibular disorders and a leukemia microarray data set.

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“…O bem-estar físico e o emocional, assim como as relações sociais, familiares e de trabalho, são extremamente afetados (Sorajjakool et al, 2006;Smith et al, 2001). A experiência da dor é mais bem entendida se uma construção multidimensional, incluindo aspectos físi-cos, biológicos, sociais, psicológicos e espirituais, for considerada (Davis et al, 2003). Além dos conceitos de nocicepção, sensitividade central e do componente neuropático da dor, numerosos estudos apontam fatores não-biológicos, como o suporte social e as estratégias de enfrentamento (coping), como fundamentais na percepção de dor dos pacientes (Keefe e Bonk, 1999;Lester et al, 1996;Kraaimaat et al, 1995).…”

Section: Introductionunclassified

A importância da integração da espiritualidade e da religiosidade no manejo da dor e dos cuidados paliativos

Peres¹,

Arantes²,

Lessa³

et al. 2007

Rev. psiquiatr. clín.

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A importância da integração da espiritualidade e da religiosidade no manejo da dor e dos cuidados paliativos ResumoContexto: Dor é um dos sintomas físicos mais freqüentemente relatados por pacientes, causando importante redução na qualidade de vida do indivíduo. Pacientes com dor crônica são difíceis de tratar. Objetivo: Descrever estratégias atuais de abordagem de pacientes com dores crônicas, baseadas na literatura científica, enfatizando medidas relacionadas à espiritualidade e à religiosidade. Método: A presente revisão utilizou-se das atuais estratégias de manejo para pacientes com dor crônica combinadas a medidas medicamentosas e não-medicamentosas, estas geralmente incorporando medidas voltadas ao bem-estar físico, mental, social e espiritual com base em publicações indexadas pelo Medline. Resultados: Muitos estudos demonstram associação positiva entre espiritualidade e religiosidade e melhora em variáveis e marcadores de doenças crônicas. Conclusão: Pelo fato de a religiosidade e a espiritualidade serem marcadamente relacionadas com a melhora clínica dos pacientes, é importante que o reconhecimento desses aspectos e a integração no manejo dos pacientes com dor crônica sejam conduzidos por profissionais da área de saúde.Peres, M.F.P. et al. / Rev. Psiq. Clín. 34, supl 1; 82-87, 2007 Palavras-chave: Dor crônica, manejo, cefaléias, espiritualidade. AbstractBackground: Pain is one of the most common physical complaints which negatively affects the patient's quality of life. Patients with chronic pain are difficult and often frustrating to treat. Objective: To describe the current strategies for approaching patients with chronic pain based on scientific literature, emphasizing measures related to spirituality and religiosity. Method: For the present work, authors reviewed data supporting the application of clinical procedures regarding to chronic pain and palliative care with the importance of spirituality background incorporation based on indexed Medline data. Results: Many studies have demonstrated a positive association between spirituality and religiosity and improvement of chronic diseases' variables and markers. Conclusion: As religiosity and spirituality are notoriously related to the patient's clinical improvement, it is highly important that the recognition of these aspects and their incorporation in the management of patients with chronic pain be conducted by health professionals.

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Multidimensional Subgroups in Migraine: Differential Treatment Outcome to a Pain Medicine Program

Abstract: This study questions the validity of the MPI subgroup classification algorithm. The results indicate that the K-clustering approach is more useful than the MPI in deriving meaningful patient clusters that differentially predict treatment outcome in a migraine population.

Cited by 27 publications

References 24 publications

Psychological profile and self-administered relaxation in patients with craniofacial pain: a prospective in-office study

Psychological profile and self-administered relaxation in patients with craniofacial pain: a prospective in-office study

Identification of relevant subtypes via preweighted sparse clustering

A importância da integração da espiritualidade e da religiosidade no manejo da dor e dos cuidados paliativos

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