Use this URL to cite or link to this record in EThOS:
Title: Multidisciplinary pain management : psychosocial outcomes and effect on neurophysiological responses to pain
Author: Hylands-White, Nicholas
ISNI:       0000 0004 7653 2775
Awarding Body: Birmingham City University
Current Institution: Birmingham City University
Date of Award: 2018
Availability of Full Text:
Access from EThOS:
Access from Institution:
Background: The efficacy of UK National Health Service (NHS) multidisciplinary pain management programmes (PMPs) is currently measured using self-report questionnaires. Whilst subjective measurements provide important information about personal experiences, they cannot reveal underlying changes in cortical activity related to pain that may also accompany PMP treatment. There is no objective measurement of treatment efficacy currently available. This thesis contains studies of two NHS PMPs that differ in their psychological approach. The effect of these treatments was assessed using self-report questionnaire measures, and a newly developed neurophysiological assessment technique. Methods: Studies examined the effect of a cognitive-behavioural therapy (CBT) based PMP, and an acceptance and commitment therapy (ACT) based PMP, upon questionnaire measures of psychological, physical, and social health, as well as measures of coping and acceptance. Further studies examined pre- to post-treatment changes in patients' cortical pain processing measured using electroencephalography (EEG), as well as in healthy and patient (waiting list/treatment as usual) control groups. The effect of treatment on contact heat evoked potentials (CHEPs), and on changes in power spectral density (PSD) following exposure to medium duration tonic pain (90s cold pressor test) was investigated. Results: Small but significant (p < .05) improvements in self-report measures of mental health, coping, and acceptance were found in patients following both CBT- and ACT-based PMPs. There were differences in the effect of PMPs on measures of anxiety, depression and catastrophising, with the ACT-based programme data showing slightly larger effect sizes. Neurophysiological testing revealed no pattern of effect upon CHEPs, however there were pre- to post-treatment differences in the effect of tonic pain upon PSD. Alpha (α) and theta (θ) rhythms were significantly (p < .05) reduced pre-treatment in the CBT group (n=12); post-treatment this effect was not iv observed. There were no pre- to post-treatment differences in the ACT group (n=4) and there were also no changes in either healthy (n=14) or waiting list (n=13) control groups between test sessions. Conclusion: Both PMPs studied brought about small but significant improvements in patients' perceived mental and physical health. Despite their differences both programmes were clinically beneficial to patients in terms of self-report measures. Measurable change was observed in the cortical response to pain pre- to post-treatment with a CBT-based PMP, most likely due to a change in cognitive appraisal of painful signals brought about by taking part in the PMP. Results imply the possible use of neurophysiological assessment to identify patients who may benefit most from treatment, to match treatments to patients' individual psychological and neurophysiological profile, and to more closely monitor treatment efficacy.
Supervisor: Raphael, J. H. ; Khan, S. ; Mayhew, S. D. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: A300 Clinical Medicine