Effects of cognitive coping skills training on coping strategies and experimental pain sensitivity in African American adults with sickle cell disease

Depression, disease severity, and sickle cell disease

The present study examined depressive symptomatology in 440 adults with sickle cell disease (SCD). Participants completed the Center for Epidemiologic Studies--Depression scale (CES-D) as part of their yearly routine visits to the Duke University--University of North Carolina Comprehensive Sickle Cell Center. They also completed questions regarding demographics, disease severity, pain, and health care use. Data analyses revealed that the percentage of patients with SCD exhibiting significant depressive symptomatology dropped from 43 to 18% when a more stringent cutoff was used on the CES-D, suggesting that future studies should determine the most valid cutoff score for identifying depression in patients with SCD. Gender and family income were positively and significantly associated with depressive symptomatology. Also, patients who reported more frequent painful episodes were more likely to report depressive symptoms. Implications for assessment and treatment of depression in adults with SCD are discussed.

Advances in the treatment of fibromyalgia: current status and future directions

Despite significant efforts devoted to understanding the etiopathogenesis of fibromyalgia, its treatment still presents a challenge to practicing clinicians, who must recognize the disorder and quantify the different symptoms in order to treat it. This article discusses recent research to identify sensitive and reliable measures for determining response to treatment among patients with FM, and the elements of therapeutic programs (pharmacologic and nonpharmacologic) for patients with FM along with the empirical or theoretical basis for their use. Future directions, including the need for systematic, controlled outcome studies of therapies and evaluation of variables which may mediate the effects of treatment, as well as demonstration that the effects produced in outcome studies generalize to settings beyond those in which the studies are initially conducted, are also discussed.

Coping strategies and laboratory pain in children with sickle cell disease

Studies have found that coping strategies are significant predictors of pain report, health care use, and psychosocial adjustment in children with sickle cell disease (SCD); however, the mechanisms of the relationship are not clear. In this study, 41 children with SCD completed a laboratory pain task to analyze their pain perception under standardized conditions. Sensory decision theory analyses were used to analyze the pain perception data. Children and their parents also completed measures of coping strategies and adjustment. Hierarchical regression analyses controlling for the child's age indicated that children who reported using active cognitive and behavioral coping strategies had a lower tendency to report pain during the laboratory pain task. Results are discussed in terms of the utility of using laboratory pain models with children and the need for future intervention studies to target coping strategies in children with SCD pain.

Psychosocial determinants of health care utilization in sickle cell disease patients

This article reviews the literature on psychosocial factors associated with sickle cell disease and health care utilization. The Health Belief Model is proposed as a framework that may help guide our understanding about how these variables influence health care utilization. Since the existing literature on psychosocial variables and health care utilization among sickle cell disease patients is scant, studies from related behavioral medicine research will be presented as a basis for future research. This review suggests that identifying modifiable psychosocial variables associated with utilization could aid in the development of interventions aimed at reducing utilization and thereby reducing health care costs.

The role of cognitive-behavioural therapy in the management of pain in patients with sickle cell disease

Painful crisis is the most common manifestation of sickle cell disease and accounts for the second greatest number of admissions with an average length of stay of 7 days in central London. Despite this frequency of admissions, the management of pain is fraught with problems. This is not surprising since the psychological challenges presented by sickle cell disease are manifold, resulting in significant psychological distress for some individuals. This paper considers the literature on the psychosocial impact of sickle cell disease, and the American research evidence which suggests that pain management strategies that incorporate a psychological intervention can significantly reduce psychological distress as well as hospital admissions. Britain has been slow to incorporate psychology in the pain management strategies, and we have embarked on research to fill this gap. Although this research constitutes work in progress, an argument is put forward for utilizing the cognitive-behavioural perspective in the management of pain in sickle cell disease and we conclude by giving a brief summary of pilot work which is both the foundation and justification for the current ongoing research.

Cognitive coping skills training in children with sickle cell disease pain

This study was designed to examine whether brief training in cognitive coping skills would enhance pain coping strategies and alter pain perception in children and adolescents with sickle cell disease (SCD). Forty-nine participants with SCD were randomly assigned to either a cognitive coping skills condition or a standard care control condition. At pre- and posttesting, coping strategies and pain sensitivity using laboratory pain stimulation were measured. Results indicated that in comparison to the randomly assigned control condition, brief training in cognitive coping skills resulted in decreased negative thinking and lower pain ratings during low intensity laboratory pain stimulation.

Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli

OBJECTIVE

To examine how self-efficacy for arthritis pain relates to the perception of controlled laboratory pain stimuli.

METHODS

Forty patients with osteoarthritis completed self-report measures of self-efficacy for arthritis pain. They then participated in a single experimental session in which measures of thermal pain threshold and tolerance were collected, as well as measures of the perceived intensity and unpleasantness of a range of thermal pain stimuli.

RESULTS

Correlational analyses revealed that patients reporting high self-efficacy for arthritis pain rated the thermal pain stimuli as less unpleasant than those reporting low self-efficacy. When subjects scoring very high and very low in self-efficacy were compared, it was found that subjects scoring high on self-efficacy for arthritis pain had significantly higher pain thresholds and pain tolerance than those scoring low on self-efficacy.

CONCLUSIONS

These results indicate that self-efficacy for arthritis pain is related to judgments of thermal pain stimuli. Implications for the understanding of arthritis pain and for future laboratory research are discussed.

The stability of pain coping strategies in young children adolescents, and adults with sickle cell disease over an 18-month period

OBJECTIVE

The current study assessed stability of pain coping strategies over an 18-month period in adults, adolescents, and young children with sickle cell disease.

DESIGN

Eighteen-month longitudinal study. Assessments of coping strategies were done at baseline, 9 months, and 18 months.

PATIENTS

A total of 141 patients with sickle cell disease (SCD) presenting to adult and pediatric sickle cell clinics for regularly scheduled check-ups.

OUTCOME MEASURES

Coping Strategy Questionnaire subscales (Coping Attempts, Negative Thinking, and Illness-Focused Strategies).

RESULTS

pearson Product-Moment correlation coefficients comparing baseline and 18-month follow-up coping data were highly significant for Coping Attempts and Negative Thinking/Illness Focused Strategies for adults. For young children, the 18-month follow-up scores on Negative Thinking were significantly correlated with baseline scores, however, no other 18-month correlations were significant. The results from the adolescent subset of subjects indicated no significant correlations on any of the coping strategies from baseline to 18-month-follow-up. Stability was also assessed using intraclass correlations, which incorporates more than two test-retest values on the same subjects. These analyses confirmed that coping strategies in adults were highly stable, whereas for children and adolescents, there was instability ANOVAs indicated that adolescents scored significantly higher than young children on Negative Thinking and Illness-Focused Strategies at baseline and follow-up.

CONCLUSIONS

As compared with the highly stable coping evidenced in adults with SCD, coping in children and adolescents with SCD is more variable. Thus, interventions should target children early before maladaptive coping patterns become entrenched.

Biobehavioral pain research: a multi-institute assessment of cross-cutting issues and research needs

In 1994 ten NIH institutes sponsored an interagency workshop focusing on biobehavioral pain research. The workshop had three major goals: (1) to review the current status of biobehavioral pain research (2) to identify critical research needs, and (3) to enhance interdisciplinary and interagency cooperation in pain research. The purpose of this article is to summarize the presentations at this meeting and to highlight some of the key research recommendations. Research topics addressed include (a) understanding critical interfaces between biology and behavior; (b) pain, suffering, and emotion; (c) pain and behavior; (d) behavior-related interventions; (e) commonalities and differences in pain expression, experience, and treatment; and (f) pain in special populations. The article concludes with a summary of NIH pain research activities that have taken place since the workshop.