Multidisciplinary Pain management: Psychosocial Outcomes and Effect on Neurophysiological Responses to Pain

Hylands-White, Nicholas (2018) Multidisciplinary Pain management: Psychosocial Outcomes and Effect on Neurophysiological Responses to Pain. Doctoral thesis, Birmingham City University.

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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.


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.


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.


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.

Item Type: Thesis (Doctoral)
Additional Information: I extend my sincere gratitude and appreciation to all those people without whom this thesis would not have been possible: Prof. Jon Raphael; Prof. Robert Ashford; Prof. Maxine Lintern; Dr. Rui Duarte; Dr. Elizabeth Sparkes; Dr. Benjamin Newton; Sue Clarke; Lovain Hynes; Dr. Salim Khan; Dr. Khalid Alnababtah; Dr. Tarek Raheem; Naomi Vanlint; Lisa Bentley; Stacey Mann; Shanaz Pasha; Dr. Nitima Suparee; Bisola Mutingwende; Jonathan Gadsby; Tian, Sandra, Sharon, Zoe, Jas; Dr. Stuart Derbyshire; Dr. Stephen Mayhew; Dr. Andrew Bagshaw; Karen LeMarchand; Margaret, Sue, Sally-Ann; Simon Biggs; Claire Beddall; Claire Richards; Margaret Marriott; Lisa Tidmarsh; All the patients, staff, and students who volunteered to take part. Most importantly, My parents, Nigel and Jacqueline Hylands-White, for your unwavering support. My dear wife, Monique Lee Hylands-White, who has been there for me every step of the way.
9 July 2018Completed
Uncontrolled Keywords: chronic pain; pain management; EEG; cognitive behavioural therapy; acceptance and commitment therapy
Subjects: CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-01 - medical sciences (non-specific)
Divisions: Doctoral Research College > Doctoral Theses Collection
Depositing User: Kip Darling
Date Deposited: 26 Feb 2019 16:21
Last Modified: 12 Jan 2022 11:13

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