Development and Initial Validation of the Pain Resilience Scale

Validation of the Pain Resilience Scale in Chinese-speaking patients with temporomandibular disorders pain

To validate the Pain Resilience Scale (PRS) for use in Chinese patients with temporomandibular disorders (TMD) pain. According to international guidelines, the original PRS was first translated and cross-culturally adapted to formulate the Chinese version of PRS (PRS-C). A total of 152 patients with TMD pain were recruited to complete series of questionnaires. Reliability of the PRS-C was investigated using internal consistency and test-retest reliability. Validity of the PRS-C was calculated using cross-cultural validity and convergent validity. Cross-cultural validity was evaluated by examining the confirmatory factor analysis (CFA). And convergent validity was examined through correlating the PRS-C scores with scores of 2 commonly used pain-related measures (the Connor-Davidson Resilience Scale [CD-RISC] and the Tampa Scale for Kinesiophobia for Temporomandibular Disorders [TSK-TMD]). The PRS-C had a high internal consistency (Cronbach's alpha = 0.92) and good test-retest reliability (intra-class correlation coefficient [ICC] = 0.81). The CFA supported a 2-factor model for the PRS-C with acceptable fit to the data. The fit indices were chi-square/DF = 2.21, GFI = 0.91, TLI = 0.97, CFI = 0.98 and RMSEA = 0.08. As regards convergent validity, the PRS-C evidenced moderate-to-good relationships with the CD-RISC and the TSK-TMD. The PRS-C shows good psychometric properties and could be considered as a reliable and valid measure to evaluate pain-related resilience in patients with TMD pain.

Predicting Low Back Pain Outcomes: Suggestions for Future Directions

Chronic low back pain (LBP) is a common and costly musculoskeletal pain condition, and effective treatment of LBP represents a significant goal of physical therapists. Establishing a targeted track of treatment for patients with LBP at high risk for chronicity that is focused on modifiable prognostic factors could have significant personal and societal benefit. Such an approach would require that clinicians accurately predict the patients who are at an elevated risk of developing chronic LBP in the early stages of the condition. In this Viewpoint, we consider the strengths and limitations of existing literature and propose suggestions that may lead to the development of parsimonious, cost-effective, and accurate predictive models of LBP chronicity. J Orthop Sports Phys Ther 2017;47(9):588-592. doi:10.2519/jospt.2017.0607.

The effect of resilience on task persistence and performance during repeated exposure to heat pain

The Pain Resilience Scale was recently developed to assess dimensions of resilience critical to pain-related adaptation and was found to predict experimental pain sensitivity in a pain-free population. Pain resilience has also been theoretically linked to behavioral persistence despite pain. To date, however, this hypothesis has not been experimentally tested. To address this gap in the literature, in the current study 105 healthy young adults underwent a baseline administration of the Paced Auditory Serial Addition Test (PASAT), a stressful mental arithmetic task, delivered with somatosensory distraction (i.e. detection of warm and cool thresholds), and finally simultaneous administration of the PASAT and a series of five heat pain threshold assessments. Results of hierarchical multiple linear regressions indicated that, after controlling for scores on a baseline PASAT and pain sensitivity, pain resilience was positively related to task persistence, B = 0.12, p = 0.04, and task performance, B = 0.14, p = 0.04, on the PASAT. These findings provide novel support for the relationship between pain resilience and behavioral perseverance.

Validation of the Pain Resilience Scale in a Chronic Pain Sample

Psychosocial factors that protect against negative outcomes for individuals with chronic pain have received increased attention in recent years. Pain resilience, or the ability to maintain behavioral engagement and regulate emotions as well as cognitions despite prolonged or intense pain, is one such factor. A measure of pain-specific resilience, the Pain Resilience Scale, was previously identified as a better predictor of acute pain tolerance than general resilience. The present study sought to validate this measure in a chronic pain sample, while also furthering understanding of the role of pain resilience compared with other protective factors. Participants with chronic pain completed online questionnaires to assess factors related to positive pain outcomes, pain vulnerability, pain intensity, and quality of life. A confirmatory factor analysis confirmed the 2-factor structure of the Pain Resilience Scale previously observed among respondents without chronic pain, although one item from each subscale was dropped in the final version. For this chronic pain sample, structural equation modeling showed that pain resilience contributes unique variance to a model including pain acceptance and pain self-efficacy in predicting quality of life and pain intensity. Further, pain resilience was a better fit in this model than general resilience, strengthening the argument for assessing pain resilience over general resilience.

PERSPECTIVE

A modified version of the Pain Resilience Scale retained the original factor structure when tested in a chronic pain sample. Construct validity was supported by expected relationships with pain-related protective and vulnerability measures. Further, a model including positive pain constructs showed that pain resilience accounts for unique variability when predicting quality of life and pain intensity.

Behavioral Inhibition and Behavioral Activation are Related to Habituation of Nociceptive Flexion Reflex, but Not Pain Ratings

Habituation (ie, decreases in responding) and sensitization (ie, increases in responding) after prolonged or repeated exposures to a fixed stimulus have been identified as important in adaptation to repeated or prolonged noxious stimulation. Determinants of habituation or sensitization are poorly understood, and experimental investigation of habituation of pain ratings have generally relied on pain reports and statistical techniques that average responses across a group of participants. Using a cross-sectional design, the current study used multilevel growth curve analyses to examine changes in the nociceptive flexion reflex (NFR), a spinal nociceptive withdrawal reflex, and pain ratings in response to 12 repeated, constant intensity, noxious electrocutaneous stimuli. Unconditional growth curve models indicated that, on average, participants evidenced habituation of the NFR and sensitization of pain ratings. However, a substantial subgroup of participants exhibited the opposite pattern of change. In conditional models, behavioral inhibition, b = .10, P = .003, and behavioral activation, b = -.07, P = .07, independently interacted with the growth curve to predict changes in NFR, but not pain ratings, across the 12 stimuli. These findings provide preliminary experimental support for Jensen and colleagues' 2-factor model of pain experience and implicate a role for approach and avoidance motivations in descending modulation of NFR.

PERSPECTIVE

Using repeated NFR stimulation, this study showed that most participants exhibited NFR habituation and pain sensitization; however, a substantial subgroup showed an opposite pattern of pain habituation (25.0%) and NFR sensitization (31.4%). Further, NFR habituation was moderated by individual differences in behavioral activation and behavioral inhibition.

Who Benefits from Chronic Opioid Therapy? Rethinking the Question of Opioid Misuse Risk

Beginning in the late 1990s, a movement began within the pain management field focused upon the underutilization of opioids, thought to be a potentially safe and effective class of pain medication. Concern for addiction and misuse were present at the start of this shift within pain medicine, and an emphasis was placed on developing reliable and valid methods and measures of identifying those at risk for opioid misuse. Since that time, the evidence for the safety and effectiveness of chronic opioid therapy (COT) has not been established. Rather, the harmful, dose-dependent deleterious effects have become clearer, including addiction, increased risk of injuries, respiratory depression, opioid induced hyperalgesia, and death. Still, many individuals on low doses of opioids for long periods of time appear to have good pain control and retain social and occupational functioning. Therefore, we propose that the question, “Who is at risk of opioid misuse?” should evolve to, “Who may benefit from COT?” in light of the current evidence.