JYU DISSERTATIONS 95 Elsa A. Campbell Vibroacoustic Treatment and Self-care for Managing the Chronic Pain Experience An Operational Model JYU DISSERTATIONS 95 Elsa A. Campbell Vibroacoustic Treatment and Self-care for Managing the Chronic Pain Experience An Operational Model Esitetään Jyväskylän yliopiston humanistis-yhteiskuntatieteellisen tiedekunnan suostumuksella julkisesti tarkastettavaksi yliopiston vanhassa juhlasalissa S212 kesäkuun 15. päivänä 2019 kello 12. Academic dissertation to be publicly discussed, by permission of the Faculty of Humanities and Social Sciences of the University of Jyväskylä, in building Seminarium, auditorium S212 on June 15, 2019 at 12 noon. JYVÄSKYLÄ 2019 Editors Esa Ala-Ruona Department of Music, Art and Culture Studies, University of Jyväskylä Ville Korkiakangas Open Science Centre, University of Jyväskylä Cover image by Elsa A. Campbell. Copyright © 2019, by University of Jyväskylä Permanent link to this publication: http://urn.fi/URN:ISBN:978-951-39-7791-7 ISBN 978-951-39-7791-7 (PDF) URN:ISBN:978-951-39-7791-7 ISSN 2489-9003 ABSTRACT Campbell, Elsa A. Vibroacoustic treatment and self-care for managing the chronic pain experience: An operational model Jyväskylä: University of Jyväskylä, 2019, 94 p. (JYU Dissertations ISSN 2489-9003; 95) ISBN 978-951-39-7791-7 (PDF) Chronic pain – pain which lasts longer than three months – is a physiological, psychological, and social phenomenon affecting approximately 20-33% of the world’s population. It contributes to disability, work absenteeism and presenteeism, as well as having economic ramifications. The psychological aspect of chronic pain manifests most commonly in comorbid mood disorders, namely depression and anxiety. They are individually difficult to manage due to their inherently subjective nature; as a combination they are pervasively under-treated. It is understood that chronic pain and mood disorders have a common neurological basis, which supports the use of psychological approaches, such as Cognitive Behavioural Therapy, or mood-targeted pharmacotherapy such as antidepressants, in the management of pain. Vibroacoustic (VA) treatment is both a physiological and psychological approach, beneficial in pain and mood management, however the effects are generally short-term. This dissertation addresses the question of whether practitioner-led VA treatment can be used to manage the psychophysiological symptoms of chronic pain, and whether an adjunct self-care phase is helpful in prolonging the effects. Article I, an interview study, describes the development, current knowledge, and future directions of VA treatment; Article II outlines the standard protocol followed at the multidisciplinary rehabilitation unit at Seinäjoki Central Hospital for multi-symptom patients; Article III explores the role of music listening within VA treatment in a clinical setting; lastly, Articles IV and V investigate the relevance and effects of an adjunct self-care phase to VA treatment sessions offered at the rehabilitation unit. A layered system of outcome measures was also used in these mixed methods studies. Subjective reports were supported by quantitative scales which were further supported by the addition of exploratory physiological outcome measures. The comorbidity of pain and mood disorders was examined in addition to the impact this had on functioning and ability to work, a focal point of the rehabilitation unit featured in the work. Cumulatively, the findings from all five articles, as well as supporting literature, are the foundation upon which the proposed operational model of VA treatment with self-care is based. Keywords: vibroacoustic treatment, chronic pain, depression, anxiety, functioning, operational model TIIVISTELMÄ (FINNISH ABSTRACT) Campbell, Elsa A. Vibroakustinen- ja itsehoito kroonisen kivun hoidossa: Toimintamallin kehittä- minen ja testaaminen Jyväskylä: University of Jyväskylä, 2019, 94 p. (JYU Dissertations ISSN 2489-9003; 95) ISBN 978-951-39-7791-7 (PDF) Krooninen kipu – kipu, joka kestää pidempään kuin kolme kuukautta – on fy- siologinen, psykologinen ja sosiaalinen ilmiö, joka vaikuttaa noin 20–33 % maa- ilman väestöstä. Se on syynä työkyvyttömyyteen, työpoissaoloihin ja presen- teismiin (sairaana töihin tuleminen) sekä niiden myötä ilmeneviin taloudellisiin seurannaisvaikutuksiin. Kroonisen kivun psykologiset vaikutukset ilmenevät yleisimmin mielialahäiriöinä, erityisesti masennuksena ja ahdistuneisuutena. Ne ovat erikseen vaikeahoitoisia subjektiivisen luonteensa vuoksi ja yhdistel- mänä laaja-alaisesti alihoidettuja. Kroonisella kivulla ja mielialahäiriöillä tiede- tään olevan yhteinen neurologinen perusta, joka tukee psykologisten lähesty- mistapojen, kuten esimerkiksi kognitiivis-behavioraalisen terapian tai farmako- terapian, kuten masennuslääkkeiden käyttöä kivun hoidossa. Vibroakustinen (VA-) hoito on fysiologinen ja psykologinen menetelmä, josta on hyötyä kivun ja mielialan hallinnassa. Hoidon vaikutukset jäävät kuitenkin yleisesti ottaen lyhytaikaisiksi. Tässä väitöstutkimuksessa selvitettiin, onko koulutetun VA- hoitajan antamaa VA-hoitomenetelmää mahdollista käyttää psykofysiologisten oireiden ja kroonisen kivun hoidossa, ja mikäli lisätty itsehoitovaihe edesauttaa vaikutusten ylläpitämistä. Artikkeli I, haastattelututkimus, kuvailee VA-hoidon taustaa ja kehittymistä, nykyistä tutkimustietoa, ja tulevaisuuden näkymiä; Ar- tikkeli II hahmottelee nykyisen hoidon toimintamallin, joka on käytössä mo- nioireisille potilaille Seinäjoen keskussairaalan moniammatillisessa kuntou- tusyksikössä; Artikkeli III tutkii musiikin kuuntelun roolia VA-hoidon aikana kliinisessä tilanteessa; Artikkelit IV ja V tutkivat kuntoutusyksikössä annetun yksilöllisen VA-hoidon lisäksi käytetyn itsehoidollisen vaiheen merkitystä ja vaikutuksia. Näissä monimenetelmätutkimuksissa käytettiin useita erilaisia lopputulosmuuttujia; itsearviointien tukena oli määrällisiä asteikkoja, joiden lisäksi käytettiin myös fysiologisia mittareita. Kivun ja mielialahäiriöiden ko- morbiditeettiä (samanaikaisuutta) sekä niiden vaikutuksia työ- ja toimintaky- kyyn tutkittiin. Työ- ja toimintakyvyn edistyminen oli näiden potilaiden kun- toutuksen keskeisiä tavoitteita. Kaikki nämä viisi artikkelia, yhdessä taustakir- jallisuuden kanssa, toimivat perustana esitetylle VA-hoidon ja itsehoidon yhdis- tävälle toimintamallille. Avainsanat: vibroakustinen hoito, krooninen kipu, masennus, ahdistuneisuus, toimintakyky, toimintamalli Author’s address Elsa A. Campbell Department of Music, Art and Culture Studies P.O. Box 35 FI-40014 University of Jyväskylä, Finland [email protected] Supervisors Esa Ala-Ruona Department of Music, Art and Culture Studies University of Jyväskylä, Finland Birgitta Burger Department of Music, Art and Culture Studies University of Jyväskylä, Finland Reviewers Heidi Ahonen Faculty of Music Wilfred Laurier University Ana Katušić Croatian Institute for Brain Research School of Medicine, University of Zagreb Opponent Ana Katušić Croatian Institute for Brain Research School of Medicine, University of Zagreb ACKNOWLEDGEMENTS After the graduate degree, I had a plan for remaining in Jyväskylä - and it didn’t involve doing a PhD. As fate would have it, that plan was not realised and I’m so glad it wasn’t. These years have been some of the most rewarding and fortunate, but also strenuous and challenging, of my life and I wouldn’t change anything. I have found that doing a PhD is less about the final product and more about self-discovery. Many people have supported the work that is presented in these pages and in doing so you have individually and in many ways helped me to explore not only the topic but also myself. As a result, there are parts of all of you in the thousands of words describing the thousands of hours it took to complete this work. For your patience, support, advice, and the small acts that made a big difference, I humbly thank you. I am indebted to my two supervisors, Esa Ala-Ruona and Birgitta Burger. I’ve learned so much from you both and wouldn’t be at this point without your guidance. Thank you, Esa, for convincing me to do a PhD and for placing your trust in me, for bringing me back from the edge, for discussions about a myriad of topics from Russian robotics to scripts for jesters’ tears, and for making me believe that what I have to say is important. You were there from the beginning until the end and taught me how to look at things from another perspective, giving me enough space to make the mistakes I needed to. Birgitta, thanks for learning slow movements to counteract fast thinking as we both tried to avoid being always auf der Hut, for all the games and sauna parties, and for being interested and a motivator to make things happen on time. The Seinäjoki studies would never have come to fruition without the dedication and professionalism of those at the rehabilitation unit of Seinäjoki Central Hospital. A special thanks to Jouko Hynynen for not running in the other direction when I arrived at the rehabilitation unit with mountains of pa- perwork, for your genuine interest in helping people, and for your humility about the role you played in this work. Thanks to Heikki Suoyrjö, Virpi Aralin- na, and Aki Vainionpää for your support in the preparation for and execution of the research. Thanks to Jukka and Mirja Linjama of Flexound for your collab- oration and devices used in the studies, and also to Ilkka Turunen of Next Wave. Thanks to the two reviewers of this dissertation, Heidi Ahonen and Ana Katušić, for challenging