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A randomized controlled TRIal of cognitive BEhavioral therapy for high Catastrophizing in patients undergoing lumbar fusion surgery: the TRIBECA study. BMC Musculoskelet Disord 2020; 21:810. [PMID: 33276768 PMCID: PMC7718692 DOI: 10.1186/s12891-020-03826-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background Around 20% of patients undergoing spinal fusion surgery have persistent back or leg pain despite surgery. Pain catastrophizing is the strongest psychological predictor for chronic postsurgical pain. Psychological variables are modifiable and could be target for intervention. However, randomized controlled trials evaluating the effectiveness of psychological interventions to reduce chronic pain and disability after spinal fusion in a population of patients with high preoperative pain catastrophizing scores are missing. The aim of our study is to examine whether an intervention targeting pain catastrophizing mitigates the risk of chronic postsurgical pain and disability. Our primary hypothesis is that targeted perioperative cognitive behavioral therapy decreases the risk of chronic postsurgical pain and disability after spinal fusion surgery in high catastrophizing patients. Methods We will perform a two-center prospective, single-blind, randomized, controlled study comparing lumbar spinal fusion surgery outcome between 2 cohorts. Adult patients selected for lumbar spinal fusion with decompression surgery and a minimum score of 24 on the pain catastrophizing scale will be randomized with 1:1 allocation for either perioperative cognitive behavioral therapy (intervention group) or a perioperative education plus progressive exercise program (control group). Patients randomized to the intervention group will receive six individual sessions of cognitive behavioral therapy, two sessions before the operation and four after. Primary outcome is the Core Outcome Measures Index at 12 months. Secondary outcomes include pain, disability, depression and quality of life. Discussion This is the first trial that evaluates the effectiveness of cognitive behavioral therapy as a perioperative tool to improve pain and disability after spinal fusion surgery in comparison with an educational/exercise control intervention, in patients with high levels of pain catastrophizing. If perioperative cognitive behavioral therapy proves to be effective, this might have important clinical implications, reducing the incidence of chronic postsurgical pain and improving outcome after spinal fusion surgery. Trial registration Clinicaltrials (NCT03969602). Registered 31 May 2019,
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102
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Rachor GS, Penney AM. Exploring metacognitions in health anxiety and chronic pain: a cross-sectional survey. BMC Psychol 2020; 8:81. [PMID: 32767986 PMCID: PMC7412818 DOI: 10.1186/s40359-020-00455-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/28/2020] [Indexed: 01/29/2023] Open
Abstract
Background The occurrence of health anxiety (HA) in chronic pain is associated with adverse outcomes. As such, it is important to identify constructs that might influence HA and pain-related outcomes. Metacognitions are an emerging area of interest in both HA and chronic pain, but the relationship between the three factors has not been extensively examined. The current study sought to examine the role of metacognitions about health in HA and pain-related outcomes in chronic pain. Methods This study utilized a cross-sectional design. Undergraduate students with self-reported chronic pain (n = 179) completed online measures of HA, pain intensity, pain disability, and metacognitions about health. Results Regression analyses indicated that both metacognitions about biased thinking and that thoughts are uncontrollable predicted HA in chronic pain, while only metacognitions about biased thinking predicted pain-related disability beyond pain intensity. Conclusion Results demonstrate that HA and pain-related disability are not associated when taking metacognitions about health into account, suggesting that metacognitions about health at least partially account for the relationship between the two. Further, results suggest that metacognitions about biased thinking may independently influence HA and pain-related disability within chronic pain.
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103
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Gilliam WP, Schumann ME, Cunningham JL, Evans MM, Luedtke CA, Morrison EJ, Sperry JA, Vowles KE. Pain catastrophizing as a treatment process variable in cognitive behavioural therapy for adults with chronic pain. Eur J Pain 2020; 25:339-347. [PMID: 33030769 DOI: 10.1002/ejp.1671] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interdisciplinary cognitive behavioural therapy (CBT) for chronic pain is effective at improving function, mood and pain interference among individuals with disabling chronic pain. Traditionally, CBT assumes that cognitive change is an active therapeutic ingredient in the determination of treatment outcome. Pain catastrophizing, a cognitive response style that views the experience of pain as uncontrollable, permanent and destructive, has been identified as an important maladaptive cognition which contributes to difficulties with the management of chronic pain. Consequently, pain catastrophizing is commonly targeted in CBT for chronic pain. OBJECTIVES To examine change trajectories in pain catastrophizing during treatment and assess the relevance of these trajectories to outcomes at posttreatment. METHODS Participants included individuals with chronic pain (N = 463) who completed a 3-week program of interdisciplinary CBT. Pain catastrophizing was assessed weekly over the 3 weeks of treatment and latent growth curve modelling was used to identify trajectories of change. RESULTS Findings indicated the presence of two classes of linear change, one with a significant negative slope in pain catastrophizing (i.e. improved class) and the other with a non-significant slope (i.e. unchanged class). Next, latent growth mixture modelling examined treatment outcome in relation to class membership. These results indicated that individuals in the 'improved' PCS class had significantly greater improvement in pain interference and mood, as well as physical and mental quality of life compared to the 'unchanged' class. CONCLUSIONS Implications for our findings, in relation to the CBT model, are discussed.
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Affiliation(s)
- Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Matthew E Schumann
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Julie L Cunningham
- Department of Pharmacy, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michele M Evans
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Connie A Luedtke
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jeannie A Sperry
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, UK
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104
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Fallon N, Brown C, Twiddy H, Brian E, Frank B, Nurmikko T, Stancak A. Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain. Br J Pain 2020; 15:357-368. [PMID: 34377461 PMCID: PMC8339954 DOI: 10.1177/2049463720973703] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Countries across the world imposed lockdown restrictions during the COVID-19 pandemic. It has been proposed that lockdown conditions, including social and physical distancing measures, may disproportionately impact those living with chronic pain and require rapid adaptation to treatment and care strategies. Using an online methodology, we investigated how lockdown restrictions in the United Kingdom impacted individuals with chronic pain (N = 431) relative to a healthy control group (N = 88). Data were collected during the most stringent period of lockdown in the United Kingdom (mid-April to early-May 2020). In accordance with the fear-avoidance model, we hypothesised lockdown-related increases in pain and psychological distress, which would be mediated by levels of pain catastrophising. Responses indicated that people with chronic pain perceived increased pain severity, compared to their estimation of typical pain levels prior to lockdown (p < .001). They were also more adversely affected by lockdown conditions compared to pain-free individuals, demonstrating greater self-perceived increases in anxiety and depressed mood, increased loneliness and reduced levels of physical exercise (p ⩽ .001). Hierarchical regression analysis revealed that pain catastrophising was an important factor relating to the extent of self-perceived increases in pain severity during lockdown (β = .27, p < .001) and also mediated the relationship between decreased mood and pain. Perceived decreases in levels of physical exercise also related to perceptions of increased pain (β = .15, p < .001). Interestingly, levels of pain intensity (measured at two time points at pre and during lockdown) in a subgroup (N = 85) did not demonstrate a significant change. However, individuals in this subgroup still reported self-perceived pain increases during lockdown, which were also predicted by baseline levels of pain catastrophising. Overall, the findings indicate that people with chronic pain suffer adverse effects of lockdown including self-perceived increases in their pain. Remote pain management provision to target reduction of pain catastrophising and increase health behaviours including physical activity could be beneficial for this vulnerable population.
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Affiliation(s)
- Nicholas Fallon
- Department of Psychology, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Christopher Brown
- Department of Psychology, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Hannah Twiddy
- Pain management Programme, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Eleanor Brian
- Department of Psychology, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Bernhard Frank
- Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Turo Nurmikko
- Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrej Stancak
- Department of Psychology, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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105
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Zhaoyang R, Martire LM, Darnall BD. Daily pain catastrophizing predicts less physical activity and more sedentary behavior in older adults with osteoarthritis. Pain 2020; 161:2603-2610. [PMID: 32569091 PMCID: PMC7572728 DOI: 10.1097/j.pain.0000000000001959] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Musculoskeletal disorders such as knee osteoarthritis (OA) are the primary cause of chronic pain in older adults. Recommended self-management strategies for knee OA include staying physically active in the face of pain, but many patients avoid activities they are capable of doing. The overall purpose of this study was to examine the extent to which daily pain catastrophizing, a maladaptive coping strategy, could influence OA patients' physical activity and sedentary behavior. The current study used data from 143 older knee OA patients who completed electronic daily diaries for 22 days and wore an accelerometer to capture physical activity and sedentary behavior. At the beginning of each day, patients reported their pain catastrophizing regarding the day ahead. Results from multilevel models demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning. These findings support the mechanistic role of daily pain catastrophizing in the avoidance of physical activity for older OA patients, and suggest that effective interventions for pain catastrophizing may also reduce sedentary behavior and enhance physical activity, with longer-term benefits for pain management, physical function, and overall health.
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Affiliation(s)
- Ruixue Zhaoyang
- Center for Healthy Aging, The Pennsylvania State University, State College, PA, United States
| | - Lynn M. Martire
- Center for Healthy Aging, The Pennsylvania State University, State College, PA, United States
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, United States
| | - Beth D. Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, Palo Alto, CA, United States
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Giordano NA, Kane A, Jannace KC, Rojas W, Lindl MJ, Lujan E, Gelfand H, Kent ML, Highland KB. Discrete and Dynamic Postoperative Pain Catastrophizing Trajectories Across 6 Months: A Prospective Observational Study. Arch Phys Med Rehabil 2020; 101:1754-1762. [DOI: 10.1016/j.apmr.2020.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
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Pimentel SD, Adams H, Ellis T, Clark R, Sully C, Paré C, Sullivan MJ. The Sequential Relation Between Changes in Catastrophizing and Changes in Posttraumatic Stress Disorder Symptom Severity. J Trauma Stress 2020; 33:731-740. [PMID: 32479704 DOI: 10.1002/jts.22519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022]
Abstract
Catastrophizing has been discussed as a cognitive precursor to the emergence of posttraumatic stress disorder (PTSD) symptoms following the experience of stressful events. Implicit in cognitive models of PTSD is that treatment-related reductions in catastrophizing should yield reductions in PTSD symptoms. The tenability of this prediction has yet to be tested. The present study investigated the sequential relation between changes in a specific form of catastrophizing-symptom catastrophizing-and changes in PTSD symptom severity in a sample of 73 work-disabled individuals enrolled in a 10-week behavioral activation intervention. Measures of symptom catastrophizing and PTSD symptom severity were completed at pre-, mid-, and posttreatment assessment points. Cross-sectional analyses of pretreatment data revealed that symptom catastrophizing accounted for significant variance in PTSD symptom severity, β = .40, p < .001, sr = .28 (medium effect size), even when controlling for known correlates of symptom catastrophizing, such as pain and depression. Significant reductions in symptom catastrophizing and PTSD symptoms were observed during treatment, with large effect sizes, ds = 1.42 and 0.94, respectively, ps < .001. Cross-lagged analyses revealed that early change in symptom catastrophizing predicted later change in PTSD symptoms; early changes in PTSD symptom severity did not predict later change in symptom catastrophizing. These findings are consistent with the conceptual models that posit a causal relation between catastrophizing and PTSD symptom severity. The clinical implications of the findings are discussed.
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Affiliation(s)
| | - Heather Adams
- University Centre for Research on Pain and Disability, Halifax, Nova Scotia, Canada
| | - Tamara Ellis
- Centre for Rehabilitation and Health, Toronto, Ontario, Canada
| | - Robin Clark
- Kootenay Health Services, Nelson, British Columbia, Canada
| | - Craig Sully
- Kootenay Health Services, Nelson, British Columbia, Canada
| | - Catherine Paré
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Adewumi AD, Maravilla JC, Alati R, Hollingworth SA, Hu X, Loveday B, Connor JP. Multiple opioid prescribers: A genuine quest for treatment rather than aberrant behaviour. A two-decade population-based study. Addict Behav 2020; 108:106458. [PMID: 32416363 DOI: 10.1016/j.addbeh.2020.106458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/23/2020] [Accepted: 04/26/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Accessing multiple prescribers for opioid prescription, referred to as doctor-shopping, is associated with an increased risk of opioid overdose and fatalities. AIM The primary aim of this study was to assess the probability of accessing multiple prescribers among patients dispensed prescription opioids. METHOD A retrospective population-based study using the Monitoring of Drugs of Dependence system of the Medicines Monitoring Unit (MMU) of Queensland Health, Australia. We assessed the odds of accessing multiple prescribers across both -short-term (≤1 month, 2-3 months) and longer-term (4-6 months and ≥7 months). We examined the relationship between multiple doctor visits, the dispensed dose of opioid and patient's residential socioeconomic status (SES). RESULT Compared to those dispensed opioid prescriptions for ≥7-12 months, those dispensed opioids for ≤1 month were more likely to have visited ≥3 prescribers (adjusted odds ratio (aOR)) 4.06, 95% CI 4.01, 4.10, while for 2-3 months and 4-6 months the odds were aOR 2.36, 95% CI 2.33, 2.39 and aOR 1.79, 95% CI 1.74, 1.79 respectively. Patients dispensed opioid doses of ≥100 oral morphine milligram equivalent per day (MME/day) were more likely to obtain prescriptions from ≥3 prescribers compare to those receiving a dose of <20MME/day (aOR 1.90; 95% CI 1.87, 1.94). The probability of obtaining opioid prescriptions from multiple prescribers increased as the socioeconomic status decreased: aOR 1.41; 95% CI 1.38, 1.44 for lowest SES compared to the highest SES. CONCLUSION Patients were more than four time likely to be dispensed opioid prescriptions from multiple prescribers within the first 30 days of initiating opioid treatment, possibly as part of multidisciplinary referral post-hospital discharge. High dose opioid and low SES was associated with higher probability of accessing multiple prescribers.
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109
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Which Interventions Enhance Pain Self-efficacy in People With Chronic Musculoskeletal Pain? A Systematic Review With Meta-analysis of Randomized Controlled Trials, Including Over 12 000 Participants. J Orthop Sports Phys Ther 2020; 50:418-430. [PMID: 32736497 DOI: 10.2519/jospt.2020.9319] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019. STUDY SELECTION CRITERIA Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain. DATA SYNTHESIS We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively. RESULTS Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication. CONCLUSION There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418-430. doi:10.2519/jospt.2020.9319.
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110
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Kawi J, Duke A, Maduka G. Self-Efficacy and Multisite Pain Predictors among Economically Disadvantaged Women with Back Pain. Pain Manag Nurs 2020; 21:307-313. [PMID: 32278529 DOI: 10.1016/j.pmn.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/26/2019] [Accepted: 03/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic low back pain (CLBP) prevalence is higher among women and those with low socioeconomic status. Without adequate self-efficacy and subsequent self-management, patients gradually develop chronic multisite pain after one year of having CLBP alone. AIM This study investigated the predictors of self-efficacy and multisite pain among adult, economically disadvantaged women, where pain prevalence is higher. DESIGN Cross-sectional, descriptive study. SETTING Pain management center. SUBJECTS Participants (n = 50) with primary diagnosis of chronic low back pain. METHODS After Institutional Review Board approval, data collection was conducted using valid and reliable instruments measuring several variables. Controlling for age and race, multiple linear regression was used for analyses. RESULTS AND CONCLUSIONS For all predictors of self-efficacy, a significant regression equation was identified (p < .01) with R2 of .413 and variance of .643. Pain catastrophizing was a significant individual predictor (p < .05). A significant regression equation was also found for all predictors of multisite pain (p < .001) with R2 of .528 and variance of .726. Individual predictors (p < .05) were age, physical function, and numbers of pain treatments and chronic medical conditions. Study findings suggest that significant predictors can be key to advancing pain research, education, practice, and healthcare policy toward improving pain management. Particularly among this population, pain catastrophizing needs to be targeted in pain management. To minimize development of multisite pain, further investigation of identified predictors including number of chronic medical conditions and pain treatments received are necessary. Multimodal, but targeted approaches addressing these predictors are recommended, instead of costly, indiscriminate multimodal therapy. Targeted interventions can help reduce pain care disparities among socioeconomically disadvantaged women, identify high risk groups for prompt intervention, facilitate better pain response to treatments, and minimize further disability.
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Affiliation(s)
- Jennifer Kawi
- School of Nursing, University of Nevada, Las Vegas, Nevada.
| | - Alexandra Duke
- School of Nursing, University of Nevada, Las Vegas, Nevada
| | - Godwin Maduka
- Las Vegas Pain Institute and Medical Center, Las Vegas, Nevada
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111
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Othman R, Jayakaran P, Swain N, Dassanayake S, Tumilty S, Mani R. Relationships Between Psychological, Sleep, and Physical Activity Measures and Somatosensory Function in People With Peripheral Joint Pain: A Systematic Review and Meta-Analysis. Pain Pract 2020; 21:226-261. [PMID: 32696604 DOI: 10.1111/papr.12943] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Alteration in somatosensory function has been linked to pain experience in individuals with joint pain. In this systematic review we aimed to establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function that were assessed via quantitative sensory testing (QST) among individuals with joint pain. METHODS A comprehensive literature search was conducted in 6 electronic databases from their inception to July 2019. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS Seventeen studies related to joint pain were included. Pain catastrophizing, depression, anxiety, and physical activity level have been shown to have a significant (small to fair) association with several QST measures. Pressure pain threshold (PPT) is the only measure that was found to be consistently correlated with all the domains. The overall quality of evidence for all factors ranged from very low to moderate. Subgroup analysis revealed a stronger association for depression and pain catastrophizing and PPT and temporal pain summation in individuals with shoulder pain. CONCLUSION Psychological factors and physical activity levels are associated with somatosensory function in people with joint pain. These factors need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with joint pain.
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Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Suranga Dassanayake
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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112
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Adewumi AD, Maravilla JC, Alati R, Hollingworth SA, Hu X, Loveday B, Connor JP. Duration of opioid use and association with socioeconomic status, daily dose and formulation: a two-decade population study in Queensland, Australia. Int J Clin Pharm 2020; 43:340-350. [PMID: 32556897 DOI: 10.1007/s11096-020-01079-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
Background There is an association between the duration of prescription opioids use and an increased risk of serious harm, often unintentional. Objective (1) Describe the trends in duration of prescription opioids dispensing and, (2) determine the risk of long-term use (≥4 months) based on patients' socioeconomic status, daily dose in oral daily morphine milligram equivalent, and opioid formulation. Setting Residents of Queensland (2,827,727), Australia from the age 18 years and who were dispensed pharmaceutical opioids from 1 January 1997 to 31 December 2018. Method Retrospective, longitudinal population-based analysis using data obtained from the Monitoring of Drugs of Dependence system of the Monitored Medicines Unit of Queensland Health. Main outcome measure Contribution of socioeconomic status, and daily dose and opioid formulation (modified-release or immediate-release) to the risk of long-term opioid use. Results There was little difference between the number of patients dispensed opioids for ≥4 months and ≤3 months between 1997 and 2011. Thereafter, the number for those using opioids long-term increased. The highest risk of having opioids dispensed for ≥4 months were for patients in the lowest level of socioeconomic status (adjusted odds ratio 1.36; 95% CI, 1.34, 1.38), compared to people in the highest socioeconomic status areas, followed by the low-socioeconomic status areas, mid-socioeconomic status areas, and high-socioeconomic status areas respectively. The risk of being dispensed prescription opioids for ≥4 months significantly increased as the dose increased: adjusted odds ratio 1.73; 95% CI, 1.71, 1.75, adjusted odds ratio 1.89; 95% CI, 1.87, 1.92, and adjusted odds ratio 3.63; 95% CI, 3.58, 3.69 for the ≥20 to <50 oral daily morphine milligram equivalent, ≥50 to <100 oral daily morphine milligram equivalent and ≥100 oral daily morphine milligram equivalent dose categories, respectively. Conclusion Higher doses and living in a low socioeconomic status areas were associated with increased risk of long-term dispensing of opioid prescriptions.
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Affiliation(s)
- Adeleke D Adewumi
- Maryborough Hospital Pharmacy, Wide Bay Hospital and Health Service, 185 Walker Street Maryborough 4650, Herston, QLD, Australia. .,Discipline of Psychiatry, The University of Queensland, Herston, QLD, 4029, Australia. .,School of Clinical Medicine - Rural Clinical School, The University of Queensland, 2-4 Medical Place, Urraween, QLD, 4655, Australia.
| | - Joemer C Maravilla
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia
| | - Rosa Alati
- School of Public Health, Curtin University, Kent Street, Bentley Campus, Perth, WA, 6845, Australia
| | - Samantha A Hollingworth
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD, 4102, Australia
| | - Xuelei Hu
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Bill Loveday
- Monitored Medicines Unit, Chief Medical Officer and Healthcare Regulation Branch, Department of Health, Brisbane, QLD, 4000, Australia
| | - Jason P Connor
- Discipline of Psychiatry, The University of Queensland, Herston, QLD, 4029, Australia.,Centre for Youth Substance Abuse Research, The University of Queensland, 17 Upland Road, St Lucia, QLD, 4067, Australia
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Amtmann D, Bamer AM, Liljenquist KS, Cowan P, Salem R, Turk DC, Jensen MP. The Concerns About Pain (CAP) Scale: A Patient-Reported Outcome Measure of Pain Catastrophizing. THE JOURNAL OF PAIN 2020; 21:1198-1211. [PMID: 32544603 DOI: 10.1016/j.jpain.2020.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/12/2020] [Accepted: 03/07/2020] [Indexed: 01/08/2023]
Abstract
Pain catastrophizing has been recognized as an important and consistent psychosocial predictor of nearly every key pain-related outcome. The purpose of this study was to develop a new measure of pain catastrophizing using modern psychometric methodology. People with chronic pain (N = 795) responded to thirty items. Data were analyzed using item response theory, including assessment of differential item functioning and reliability. Sensitivity to change and validity were examined using data collected from patients undergoing spinal fusion surgery (n = 184) and participating in an ongoing longitudinal aging with a disability survey study (n = 1,388). The final 24-item bank had no items with significant local dependence, misfit, or differential item functioning. Results provided strong evidence of reliability and validity. Six- and 2-item short forms were developed for use when computer adaptive testing is not feasible or desirable. The item bank was named the University of Washington Concerns About Pain scale because the term "catastrophizing" was considered stigmatizing by people with chronic pain. Guidance for score interpretation was developed with extensive feedback from individuals with chronic pain. The Concerns About Pain item bank, short forms, and user manuals are free and publicly available to all users and can be accessed online at https://uwcorr.washington.edu/measures/. PERSPECTIVE: This article presents the development of the University of Washington Concerns About Pain scale, the first item response theory-based item bank of pain catastrophizing. The measure is intended for clinicians interested in improving outcomes of patients with chronic pain and for researchers who study impact of and treatment interventions aimed at reducing pain catastrophizing.
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Kendra S Liljenquist
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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114
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Delery EC, Edwards S. Neuropeptide and cytokine regulation of pain in the context of substance use disorders. Neuropharmacology 2020; 174:108153. [PMID: 32470337 DOI: 10.1016/j.neuropharm.2020.108153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022]
Abstract
Substance use disorders (SUDs) are frequently accompanied by affective symptoms that promote negative reinforcement mechanisms contributing to SUD maintenance or progression. Despite their widespread use as analgesics, chronic or excessive exposure to alcohol, opioids, and nicotine produces heightened nociceptive sensitivity, termed hyperalgesia. This review focuses on the contributions of neuropeptide (CRF, melanocortin, opioid peptide) and cytokine (IL-1β, TNF-α, chemokine) systems in the development and maintenance of substance-induced hyperalgesia. Few effective therapies exist for either chronic pain or SUD, and the common interaction of these disease states likely complicates their effective treatment. Here we highlight promising new discoveries as well as identify gaps in research that could lead to more effective and even simultaneous treatment of SUDs and co-morbid hyperalgesia symptoms.
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Affiliation(s)
- Elizabeth C Delery
- Department of Physiology and Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Scott Edwards
- Department of Physiology and Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA.
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115
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Which Psychological Factors Are Involved in the Onset and/or Persistence of Musculoskeletal Pain? An Umbrella Review of Systematic Reviews and Meta-Analyses of Prospective Cohort Studies. Clin J Pain 2020; 36:626-637. [PMID: 32379072 DOI: 10.1097/ajp.0000000000000838] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to summarize the current status of knowledge about the longitudinal association between vulnerability or protective psychological factors and the onset and/or persistence of musculoskeletal (MSK) pain. METHODS PubMed, CINAHL, PsycINFO, PubPsych, Scopus, Web of Science, gray literature, and manual screening of references were searched from inception to June 15, 2019. Systematic reviews with or without meta-analysis that explored the longitudinal association between psychological factors and the onset and/or persistence of MSK pain were identified. The AMSTAR-2 tool was used to assess the risk of bias. RESULTS Fifty-nine systematic reviews that included 286 original research studies were included, with a total of 249,657 participants (127,370 with MSK pain and 122,287 without MSK pain at baseline). Overall, our results found that exposure to many psychological vulnerability factors such as depression, anxiety, psychological distress, and fear, among others, may increase the risk of the onset and persistence of MSK pain across time. In addition, our results also showed that a range of psychological factors considered to be "protective" such as self-efficacy beliefs, better mental health, active coping strategies, or favorable expectations of recovery may reduce the risk of the onset and persistence of MSK pain. However, all these systematic reviews were evaluated to have critically low confidence based on the AMSTAR-2 tool, indicating that findings from these reviews may be informative, but should be interpreted with caution. DISCUSSION The large number of methodological flaws found across reviews gives rise to a call to action to develop high-quality systematic reviews in this field.
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116
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Mannes ZL, Ferguson EG, Perlstein WM, Waxenberg LB, Cottler LB, Ennis N. Negative health consequences of pain catastrophizing among retired National Football League athletes. Health Psychol 2020; 39:452-462. [PMID: 31999177 PMCID: PMC7165032 DOI: 10.1037/hea0000847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study examined the association between pain catastrophizing with pain interference, depressive symptoms, and health-related quality of life (HRQoL) among National Football League (NFL) retirees. METHOD Former NFL athletes from the Retired NFL Players Association (N = 90) were recruited from 2018 to 2019 via telephone and were administered measures of pain, substance use, depressive symptoms, and HRQoL. Multiple linear and binomial regression analyses examined the association of pain catastrophizing with pain interference, depressive symptoms, and HRQoL while controlling for covariates (i.e., pain intensity, concussions, opioid use, binge alcohol use, years since NFL retirement, and marital status). RESULTS Many retired NFL athletes reported moderate-severe depressive symptoms as well as poorer perceived physical health compared with general medical patients. Greater pain catastrophizing was associated with more severe pain interference, greater odds of reporting moderate-severe depressive symptoms, and lower odds of reporting average and above physical and mental HRQoL after adjusting for relevant covariates. Concussions were not associated with any of the study outcomes. CONCLUSIONS Given the findings from this study, health care professionals should monitor symptoms of catastrophizing among current and retired NFL athletes. Assessment and requisite treatment of pain catastrophizing may assist these elite athletes in reducing depressive symptoms, while improving pain interference and HRQoL in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Zachary L. Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States
| | - Erin G. Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States
| | - William M. Perlstein
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States
| | - Lori B. Waxenberg
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida P.O. Box 100231, 2004 Mowry Road, Gainesville, FL 32610
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Center for Translational Behavioral Science, Tallahassee, FL, 32306
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117
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Higgins KS, Chambers CT, Rosen NO, Sherry S, Mohammadi S, Lynch ME, Campbell-Yeo M, Clark AJ. Child catastrophizing about parent chronic pain: A potential child vulnerability factor. Br J Health Psychol 2020; 25:339-357. [PMID: 32196873 PMCID: PMC7384016 DOI: 10.1111/bjhp.12410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/13/2019] [Indexed: 01/12/2023]
Abstract
Statement of contribution What is already known on this subject?Higher rates of pain and internalizing symptoms are observed in offspring of parents with vs. without chronic pain. Greater child and parent pain catastrophizing are associated with poorer pain‐related outcomes in children. Child catastrophizing about parent chronic pain and its association with child outcomes has not been examined.
What does this study add?Greater child catastrophizing about parent chronic pain is associated with greater child internalizing and CPT pain. These effects were seen beyond the association of child and parent catastrophizing about their own pain.
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Affiliation(s)
- Kristen S Higgins
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Natalie O Rosen
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Simon Sherry
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Somayyeh Mohammadi
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Mary E Lynch
- Dalhousie University, Halifax, Nova Scotia, Canada.,QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Alexander J Clark
- Dalhousie University, Halifax, Nova Scotia, Canada.,QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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118
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Rhudy JL, Lannon EW, Kuhn BL, Palit S, Payne MF, Sturycz CA, Hellman N, Güereca YM, Toledo TA, Huber F, Demuth MJ, Hahn BJ, Chaney JM, Shadlow JO. Assessing peripheral fibers, pain sensitivity, central sensitization, and descending inhibition in Native Americans: main findings from the Oklahoma Study of Native American Pain Risk. Pain 2020; 161:388-404. [PMID: 31977838 PMCID: PMC7001897 DOI: 10.1097/j.pain.0000000000001715] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Native Americans (NAs) have a higher prevalence of chronic pain than other U.S. racial/ethnic groups, but there have been few attempts to understand the mechanisms of this pain disparity. This study used a comprehensive battery of laboratory tasks to assess peripheral fiber function (cool/warm detection thresholds), pain sensitivity (eg, thresholds/tolerances), central sensitization (eg, temporal summation), and pain inhibition (conditioned pain modulation) in healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Multiple pain stimulus modalities were used (eg, cold, heat, pressure, ischemic, and electric), and subjective (eg, pain ratings and pain tolerance) and physiological (eg, nociceptive flexion reflex) outcomes were measured. There were no group differences on any measure, except that NAs had lower cold-pressor pain thresholds and tolerances, indicating greater pain sensitivity than NHWs. These findings suggest that there are no group differences between healthy NAs and NHWs on peripheral fiber function, central sensitization, or central pain inhibition, but NAs may have greater sensitivity to cold pain. Future studies are needed to examine potential within-group factors that might contribute to NA pain risk.
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Affiliation(s)
- Jamie L. Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - Bethany L. Kuhn
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Shreela Palit
- The University of Tulsa, Department of Psychology, Tulsa, OK
- University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL
| | - Michael F. Payne
- The University of Tulsa, Department of Psychology, Tulsa, OK
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, OH
| | | | - Natalie Hellman
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - Tyler A. Toledo
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Felicitas Huber
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Mara J. Demuth
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - John M. Chaney
- Oklahoma State University, Department of Psychology, Stillwater, OK
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119
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Miller MB, Roumanis MJ, Kakinami L, Dover GC. Chronic Pain Patients' Kinesiophobia and Catastrophizing are Associated with Activity Intensity at Different Times of the Day. J Pain Res 2020; 13:273-284. [PMID: 32099451 PMCID: PMC6999761 DOI: 10.2147/jpr.s230039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/24/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To examine the relationship between baseline kinesiophobia and baseline pain catastrophizing with the 4-day average activity intensity at different times of the day while accounting for different wake and sleep-onset times in chronic pain patients. Methods Twenty-one participants suffering from idiopathic chronic pain completed baseline questionnaires about kinesiophobia, catastrophizing, disability, depression, and pain. We measured the participants' activity using accelerometers and calculated activity intensity in the morning, afternoon, and evening. We performed a 2-way repeated measures ANOVA to compare activity levels at different times of the day, and multiple linear regressions. Results Baseline kinesiophobia was significantly associated with 4-day average evening light activity and sedentary activity at all time periods while baseline catastrophizing was significantly associated with increased 4-day average light activity in the evening and more moderate to vigorous activity in the morning. Our participants engaged in more light activity on average than sedentary activity, and very little moderate-vigorous activity. Participants were most active in the afternoon. Conclusion Baseline kinesiophobia and baseline catastrophizing were not associated with the 4-day average total daily activity; however, they were associated with 4-day average activity intensities at different times throughout the day. Segmenting daily activity into morning, afternoon, evening may influence the relationship between daily activity, and kinesiophobia and pain catastrophizing. Individuals with chronic pain are less sedentary than previously thought which may affect future interventions.
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Affiliation(s)
- Matthew B Miller
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada
| | - Melissa J Roumanis
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada
| | - Lisa Kakinami
- Department of Mathematics & Statistics, Concordia University, Montreal, Canada.,PERFORM Centre, Concordia University, Montreal, Canada
| | - Geoffrey C Dover
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada.,PERFORM Centre, Concordia University, Montreal, Canada.,Centre de Recherché Interdisciplinaire en Réadaptation du Montréal Metropolitain, Montreal, Canada
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120
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Zeng Y, Tan CW, Sultana R, Chua TE, Chen HY, Sia ATH, Sng BL. Association of Pain Catastrophizing with Postnatal Depressive States in Nulliparous Parturients: A Prospective Study. Neuropsychiatr Dis Treat 2020; 16:1853-1862. [PMID: 32982241 PMCID: PMC7492715 DOI: 10.2147/ndt.s256465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND. METHODS Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5- 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger's State-Trait-Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥10, whereas the secondary outcome was a continuous variable on increases in EPDS score. RESULTS Probable PND (EPDS ≥10) occurred in 10.5% (95% CI 8.0%-13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥25) was associated with increased postdelivery EPDS scores (adjusted β estimate 0.36, 95% CI 0.15-0.57; p=0.0008), but did not meet significance for increased risk of probable PND (p=0.1770). Additionally, presence of breakthrough pain during epidural analgesia (adjusted β estimate 0.24, 95% CI 0.02-0.46; p=0.0306) and lower BMI at term (adjusted β estimate -0.04, 95% CI -0.07 to -0.01; p=0.0055) were associated with increased postdelivery EPDS scores. CONCLUSION No significant association was found between high pain catastrophizing and probable PND; however, high predelivery pain catastrophizing, presence of breakthrough pain during epidural analgesia, and lower BMI at term were associated with increased postdelivery EPDS scores. Further research will be needed to validate this association in the context of the risk of PND development.
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Affiliation(s)
- Yanzhi Zeng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Chin Wen Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Helen Yu Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Alex Tiong Heng Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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121
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Borisovskaya A, Chmelik E, Karnik A. Exercise and Chronic Pain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1228:233-253. [PMID: 32342462 DOI: 10.1007/978-981-15-1792-1_16] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this chapter, we describe the impact and etiology of chronic pain, the associated changes in the nervous system, and the mechanisms by which exercise may be able to affect and reverse these changes. Evidence for efficacy of exercise in different conditions associated with chronic pain is presented, with focus on chronic low back pain, fibromyalgia, osteoarthritis, rheumatoid arthritis, and migraines. While the efficacy of exercise and level of evidence supporting it vary in different diseases, exercise has direct and indirect benefits for most patients suffering from chronic pain. Effective exercise regimens include education and cognitive restructuring to promote behavioral activation and reconceptualization of what pain means, with the goal of gradually reversing the vicious cycle of pain, inertia, sedentary behavior, and worsening disability. Long-term, consistent, individualized exercise-based treatment approaches are most likely to result in improvements in pain and function.
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Affiliation(s)
- Anna Borisovskaya
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
- Veterans Administration Medical Center, Seattle, WA, USA.
| | - Elizabeth Chmelik
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Veterans Administration Medical Center, Seattle, WA, USA
| | - Ashwin Karnik
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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122
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Henrion A, Courtet P, Arpon-Brand V, Lafrancesca A, Lacourt L, Jaussent I, Guillaume S, Olié E, Ducasse D. PEPSUI, a Psychoeducational Program for the Management of Suicidal Patients: A Qualitative Study From a Randomized Controlled Trial. Front Psychiatry 2020; 11:500447. [PMID: 33132924 PMCID: PMC7561374 DOI: 10.3389/fpsyt.2020.500447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suicide prevention after a recent suicide attempt remains a major issue for clinicians. Indeed, these patients are at risk of new attempts and also less prone to interact with mental health services. As psychoeducation-based interventions are strongly recommended for patients with severe or chronic disorders and poor adherence, we developed the first French program of suicide psychoeducation (PEPSUI). METHODS We started a large multicenter randomized controlled trial in outpatients who attempted suicide in the last year (i.e., current suicidal behavior disorder) to assess the feasibility, acceptability, and effectiveness of a 10-week psychoeducational program (PEPSUI group: scientific information on suicidal behavior, and third-wave cognitive behavioral therapies) compared with a 10-week relaxation program (control condition), in a naturalistic setting. Here, we present the qualitative part of this study. Participants in both groups completed a narrative interview with questions on their general impressions about the therapy process and outcomes, specific areas of change in their life since inclusion, and knowledge and perceptions about suicide and mental health services. Interviews were audiotaped, transcribed, and coded using inductive and deductive thematic analysis with a constant comparative approach. Participants were consecutively included until data saturation. RESULTS The interviews of 18 patients (n=10 in the PEPSUI group, and n=8 in the relaxation group) were analyzed. Qualitative analyses revealed some common points, and many differences between groups that are relevant for suicide prevention. Patients in both groups were satisfied with the programs. Group modality and therapeutic alliance with the instructors were considered useful in both groups. Participation was related to improved perception of mental health units (particularly in the PEPSUI group). Both groups reported the acquisition of stress management skills and distress tolerance. Relaxation was an easy way to survive stress. Conversely, the PEPSUI program had deeper implications for daily life through effective positioning towards internal events (thoughts and emotions) as a consequence of mindfulness-derived practices, enhancement of value-based commitments, improvement of the meaning in life and internal locus of control, increased contact with the present moment, use of a matrix (a decision-making tool), and acquisition of scientific knowledge on suicidal behavior. CONCLUSION Through specific processes for targeting suicidal risk and reducing the stigma, the PEPSUI program may represent a promising intervention for suicide prevention.
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Affiliation(s)
- Audrey Henrion
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Philippe Courtet
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Véronique Arpon-Brand
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Audrey Lafrancesca
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Laetitia Lacourt
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Isabelle Jaussent
- INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Sébastien Guillaume
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Emilie Olié
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Déborah Ducasse
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
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123
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Martinez-Calderon J, Meeus M, Struyf F, Diaz-Cerrillo JL, Clavero-Cano S, Morales-Asencio JM, Luque-Suarez A. Psychological factors are associated with local and generalized pressure pain hypersensitivity, pain intensity, and function in people with chronic shoulder pain: A cross-sectional study. Musculoskelet Sci Pract 2019; 44:102064. [PMID: 31605982 DOI: 10.1016/j.msksp.2019.102064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To explore the association between psychological factors and shoulder pain intensity, function, as well as local and generalized pressure pain hypersensitivity. DESIGN a cross-sectional study. METHODS 90 participants with chronic shoulder pain were included. Pressure pain thresholds determined the presence of pain hypersensitivity. Pain intensity, function, pain self-efficacy, emotional distress, and pain catastrophizing were also assessed. Analyses were adjusted for gender and age. RESULTS The diagnosis of depression (yes/no answer) was associated with both greater local (standardized β = -0.19[95%CI -0.37 to -0.00]) and generalized (standardized β = -0.20[95%CI -0.39 to -0.01]) pressure pain hypersensitivity. Greater pain self-efficacy was associated with lower local pressure pain hypersensitivity (standardized β = 0.19[95%CI 0.04 to 0.38]). The standardized beta coefficient for the diagnosis of depression indicated that this variable showed the strongest association with pressure pain hypersensitivity. Additionally, greater pain self-efficacy was associated with lower pain intensity (standardized β = -0.34[95%CI -0.51 to -0.17]) and better function (standardized β = -0.47[95%CI -0.63 to -0.30]). Greater pain catastrophizing was associated with more pain intensity (standardized β = 0.35[95%CI 0.18 to 0.52]) and worse function (standardized β = 0.26[95%CI 0.10 to 0.43]). The standardized beta coefficients for pain catastrophizing and pain self-efficacy indicated that both variables showed the strongest association with shoulder pain intensity and function, respectively CONCLUSION: Psychological factors were associated with local and generalized pressure pain hypersensitivity, pain intensity, and function in people with chronic shoulder pain.
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Affiliation(s)
- Javier Martinez-Calderon
- Universidad de Malaga, Facultad Ciencias de la Salud, Departamento de Fisioterapia, Malaga, Spain; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium; Department of Rehabilitation Sciences and Physiotherapy Department, Ghent University, Ghent, Belgium; Pain in Motion International Research Group, Belgium.
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | | | - Jose Miguel Morales-Asencio
- Universidad de Malaga, Facultad Ciencias de la Salud, Departamento de Enfermería, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Alejandro Luque-Suarez
- Universidad de Malaga, Facultad Ciencias de la Salud, Departamento de Fisioterapia, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
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Kedroff L, Li Ko Lun A, Shimoni D, Bearne LM. Cognitive behavioural therapy-informed physiotherapy for patellofemoral pain: A feasibility study. Musculoskeletal Care 2019; 17:382-389. [PMID: 31691524 DOI: 10.1002/msc.1429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Louise Kedroff
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Alain Li Ko Lun
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Doron Shimoni
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Lindsay M Bearne
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
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125
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Schütze R, Rees C, Smith A, Slater H, O’Sullivan P. Metacognition, perseverative thinking, and pain catastrophizing: A moderated‐mediation analysis. Eur J Pain 2019; 24:223-233. [DOI: 10.1002/ejp.1479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Robert Schütze
- School of Psychology Curtin University Perth Australia
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Clare Rees
- School of Psychology Curtin University Perth Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Peter O’Sullivan
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
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Rajappa H, Wilson M, White R, Blanchard M, Tardif H, Hayes C. Prioritizing a sequence of short-duration groups as the standardized pathway for chronic noncancer pain at an Australian tertiary multidisciplinary pain service: preliminary outcomes. Pain Rep 2019; 4:e780. [PMID: 31875185 PMCID: PMC6882570 DOI: 10.1097/pr9.0000000000000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe implementation and report preliminary outcomes of a resource-efficient, standardized group pathway for chronic noncancer pain. DESIGN Descriptive cross-sectional study of a group-based pain management pathway in comparison with an Australasian benchmarking data set. SETTING An Australian tertiary multidisciplinary pain service. SUBJECTS Patients with chronic noncancer pain actively participating in the group pathway in 2016. METHODS Referred patients were prioritized to a short-duration group-based standardized pain management pathway linking education, assessment, and treatment groups. Measures of pain, mood, self-efficacy, and catastrophizing and reduction in daily opioid use were collated from the Australasian data set. RESULTS In 2016, 928 patients were actively engaged with the pain service. More patients were prioritized to receive treatment in a group format in comparison with other Australasian services (68.4% vs 22%). A greater percentage of patients attended their first clinical contact within 3 months of referral (81.4%) compared with the Australasian average (68.6%). Comparable improvements in average pain intensity, pain interference, depression, anxiety, stress, pain catastrophizing, and self-efficacy were observed. There was significantly greater reduction in opioid use, including for those taking more than 40 mg of oral morphine equivalent daily dose. CONCLUSION Implementation of a sequence of short-duration groups as the default clinical pathway resulted in shorter waiting times and noninferior outcomes in key areas for patients completing the program, compared with Australasian averages. Given the resource efficiencies of the group process, this finding has implications for service design.
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Affiliation(s)
- Hema Rajappa
- Hunter Integrated Pain Service, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Michelle Wilson
- Hunter Integrated Pain Service, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Ruth White
- Hunter Integrated Pain Service, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Megan Blanchard
- Electronic Persistent Pain Outcomes Collaboration (ePPOC), Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Hilarie Tardif
- Electronic Persistent Pain Outcomes Collaboration (ePPOC), Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Chris Hayes
- Hunter Integrated Pain Service, Hunter New England Health, Newcastle, New South Wales, Australia
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127
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Conservative Interventions Reduce Fear in Individuals With Chronic Low Back Pain: A Systematic Review. Arch Phys Med Rehabil 2019; 101:329-358. [PMID: 31473206 DOI: 10.1016/j.apmr.2019.08.470] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To systematically review and critically appraise the effectiveness of conservative and surgical interventions to reduce fear in studies of people with chronic low back pain, based on the analysis of randomized controlled trials for which fear was a primary or secondary outcome. DATA SOURCES Electronic databases PubMed, CINAHL, PsycINFO, PEDro, and CENTRAL, as well as manual searches and grey literature were searched from inception until May 2019. STUDY SELECTION Randomized controlled trials analyzing the effectiveness of conservative and surgical interventions to reduce fear were included. DATA EXTRACTION Two reviewers independently conducted the search strategy, study selection, data extraction, risk of bias assessment, and quality of the evidence judgment. DATA SYNTHESIS Sixty-one studies (n=7201) were included. A large number of fear-related search terms were used but only 3 fear constructs (kinesiophobia, fear-avoidance beliefs, fear of falling) were measured in the included studies. Multidisciplinary and psychological interventions as well as exercise reduced kinesiophobia. Fear-avoidance beliefs were reduced by the aforementioned interventions, manual therapy, and electrotherapy. A multidisciplinary intervention reduced the fear of falling. There was moderate evidence of multidisciplinary interventions and exercise to reduce kinesiophobia. There was moderate evidence of manual therapy and electrotherapy to reduce fear-avoidance beliefs. CONCLUSIONS The present systematic review highlights the potential effectiveness of conservative interventions to reduce kinesiophobia and fear-avoidance beliefs in individuals with chronic low back pain. This information can help health professionals to reduce fear when treating patients with this condition.
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128
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The Relationship Between Level of Catastrophizing and Mental Health Comorbidity in Individuals With Whiplash Injuries. Clin J Pain 2019; 35:880-886. [PMID: 31433319 DOI: 10.1097/ajp.0000000000000749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pain catastrophizing has been shown to be correlated with measures of mental health problems such as depression and post-traumatic stress disorder (PTSD). However, the clinical implications of findings reported to date remain unclear. To date, no study has been conducted to determine meaningful cut-scores on measures of catastrophizing indicative of the heightened risk of mental health comorbidity. One objective of the present study was to identify the cut-score on the Pain Catastrophizing Scale (PCS) indicative of the heightened risk of the comorbidity of depression and PTSD. A second objective was to determine whether mental health comorbidity mediated the relationship between catastrophizing and occupational disability. MATERIALS AND METHODS The sample consisted of 143 individuals with whiplash injuries. Pain severity, pain catastrophizing, depression, and post-traumatic stress symptoms were assessed after admission to a rehabilitation program. Mental health comorbidity was operationally defined as obtaining a score above the clinical threshold on measures of depressive and/or post-traumatic stress symptom severity. RESULTS A receiver operating characteristic curve analysis revealed that a PCS score of 22 best distinguished between participants with and without mental health comorbidity. Results also revealed that mental health comorbidity mediated the relationship between catastrophizing and occupational disability. DISCUSSION The findings suggest that a score of ≥22 on the PCS should alert clinicians to the possibility that patients might also be experiencing clinically significant symptoms of depression or PTSD. Greater attention to the detection and treatment of mental health conditions associated with whiplash injury might contribute to more positive recovery outcomes.
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129
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Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clin Obstet Gynecol 2019; 62:22-36. [PMID: 30383545 DOI: 10.1097/grf.0000000000000412] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.
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130
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Matias BA, Vieira I, Pereira A, Duarte M, Silva AG. Pain neuroscience education plus exercise compared with exercise in university students with chronic idiopathic neck pain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background/AimsNeck pain is a common complaint. Its prevalence is particularly high in university students. This study examined the effects of pain neuroscience education plus exercise when compared with exercise only in university students with chronic idiopathic neck pain.MethodsUniversity students with chronic neck pain were randomly allocated to receive pain neuroscience education plus exercise, or exercise only intervention, and assessed at baseline, after the intervention and at 3-month follow-up. Pain intensity (primary outcome), disability, fear of movement, catastrophising, knowledge of pain neurophysiology, pressure pain thresholds and neck and scapular muscle endurance were measured to determine the impact of the interventions.ResultsIt was found that disability (F=17.3, P<0.001; partial eta2=0.48), fear of movement (F=5.3, P=0.009; partial eta2=0.22), catastrophising (F=16.4, P<0.001; partial eta2=0.48) and neck extensor endurance (F=11.0, P=0.002; partial eta2=0.19) changed significantly over time. There was a significant increase in neurophysiology of pain questionnaire score for the group receiving pain neuroscience education plus exercise but not for the group receiving exercise only (group vs time interaction: F=19.8, P<0.001; partial eta2=0.51). No other significant differences were found.ConclusionsPain neuroscience education plus exercise has comparable results to exercise only, with the exception of knowledge about pain neurophysiology. The impact of this difference needs to be explored in future studies.
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Affiliation(s)
- Beatriz A Matias
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Isabel Vieira
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Artur Pereira
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Mário Duarte
- Physiotherapist, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- Assistant Professor, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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132
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Schütze R, Rees C, Smith A, Slater H, Catley M, O’Sullivan P. Assessing Beliefs Underlying Rumination About Pain: Development and Validation of the Pain Metacognitions Questionnaire. Front Psychol 2019; 10:910. [PMID: 31080425 PMCID: PMC6497779 DOI: 10.3389/fpsyg.2019.00910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/04/2019] [Indexed: 01/30/2023] Open
Abstract
Metacognitions, which are beliefs about our own thinking processes, can modulate worry and rumination and thereby influence emotional distress. This study aimed to develop a self-report measure of unhelpful pain-related metacognitions which might serve as a clinical and research tool to better understand pain catastrophizing, a significant risk factor for adverse pain outcomes. Two phases of validation are presented. Phase 1 reports on how the Pain Metacognitions Questionnaire (PMQ) was empirically developed through a qualitative study of 20 people with chronic back (n = 15) or knee (n = 5) pain in secondary or tertiary care and then validated in a large internet sample of people experiencing pain (N = 864). Rasch analysis yielded a 21-item scale with two dimensions (positive and negative metacognition) assessing how useful and problematic people believe rumination about pain to be, respectively. In Phase 2, further validation using a new sample (N = 510) replicated initial findings. Both PMQ subscales have good retest reliability (r = 0.76, r = 0.72) and internal consistency (0.86, 0.87). They correlate negatively with mindfulness and positively with pain intensity, disability, anxiety, depression, catastrophizing, rumination, and metacognition. The PMQ also predicts unique variance in catastrophizing when other variables are controlled and predicts 'patient' status for pain catastrophizing. Sensitivity analysis yielded preliminary suggestions for clinically meaningful cut-offs. Unhelpful pain metacognitions can be validly and reliably measured using a self-report instrument. Future studies using the PMQ might shed new light on pain-related thinking processes to develop better interventions for people prone to worry and rumination about their pain.
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Affiliation(s)
- Robert Schütze
- School of Psychology, Curtin University, Perth, WA, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Clare Rees
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Mark Catley
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Peter O’Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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134
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Ducasse D, Jaussent I, Arpon-Brand V, Vienot M, Laglaoui C, Béziat S, Calati R, Carrière I, Guillaume S, Courtet P, Olié E. Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:211-222. [PMID: 29874680 DOI: 10.1159/000488715] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/22/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. METHODS We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. RESULTS Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = -1.88 [0.34] vs. -0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. CONCLUSIONS Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention.
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Affiliation(s)
- Déborah Ducasse
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Jaussent
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Véronique Arpon-Brand
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Marina Vienot
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Camelia Laglaoui
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Séverine Béziat
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Raffaella Calati
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Carrière
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
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135
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Maras D, Balfour L, Tasca GA, Gaudet E, Aaron SD, Cameron WD, Pakhale S. Breathlessness catastrophizing relates to poorer quality of life in adults with cystic fibrosis. J Cyst Fibros 2018; 18:150-157. [PMID: 30197031 DOI: 10.1016/j.jcf.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cystic Fibrosis (CF) is the most common genetic disease affecting children and young adults in Canada. It is a multi-system disease, however lung disease is largely responsible for mortality. Treatment advances have resulted in increased life expectancy and a subsequent need to better understand psychosocial issues associated with quality of life in adults living with CF. Emerging research suggests that anxiety and depression are related to poorer health-related quality of life (HRQoL) in CF patients, but there is little research examining cognitive processes, such as breathlessness catastrophizing. The present study addresses this gap in the literature. METHODS Participants in this study are based on a convenience sample of patients recruited during their regular CF clinic appointments at a tertiary care center. Forty-five adults (Mage = 30.73 years) completed measures of lung function, depression, anxiety, pain, breathlessness catastrophizing, and HRQoL at one time point. RESULTS Results of a hierarchical multiple regression indicate that increased breathlessness catastrophizing was related to poorer HRQoL, after controlling for lung function, depression, anxiety, and pain (p < .05). Depression, pain, and breathlessness catastrophizing all emerged as significant unique predictors of HRQoL. CONCLUSIONS Breathlessness catastrophizing is a potential target for clinical intervention and might impact HRQoL. Further research on breathlessness catastrophizing in CF is warranted including longitudinal studies to examine the mechanisms by which breathlessness catastrophizing relates to HRQoL and treatment outcomes in CF.
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Affiliation(s)
- Danijela Maras
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada.
| | - Louise Balfour
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada; Psychology, The Ottawa Hospital, Canada; Faculty of Medicine, University of Ottawa, Canada
| | - Giorgio A Tasca
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada
| | - Ena Gaudet
- The Ottawa Hospital Research Institute, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
| | - William D Cameron
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
| | - Smita Pakhale
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
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Ritchie A, Kramer JM. Recent Advances in the Etiology and Treatment of Burning Mouth Syndrome. J Dent Res 2018; 97:1193-1199. [PMID: 29913093 DOI: 10.1177/0022034518782462] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Burning mouth syndrome (BMS) is a debilitating condition that has a striking female predilection. Although the oral mucosa is normal in appearance, patients with BMS experience oral burning that most commonly localizes to the lips and tongue. BMS is a diagnosis of exclusion, and all underlying pathoses associated with allodynia must be ruled out prior to rendering the diagnosis. The etiopathogenesis of BMS remains poorly understood, and thus patient management is challenging. Data indicate that oral and systemic factors both contribute to the development and persistence of the condition. Of particular interest, emerging work identifies structural and functional deficits within the nervous system that may lead to a more mechanistic understanding of BMS pathology. In addition, several novel findings suggest that circadian rhythm dysfunction may be a previously unappreciated yet clinically significant driver of disease. Circadian rhythm controls pain perception, mood, and sleep and plays a key role in the regulation of the hypothalamic-pituitary-adrenal axis. Since these are altered in patients with BMS, this may be reflective of underlying circadian dysfunction. While evidence-based treatment strategies for BMS are lacking, current treatment approaches consist of local and systemic medications, such as clonazepam, alpha lipoic acid, capsaicin, low-level laser therapy, gabapentin, and amitriptylin. In addition, the use of cognitive behavioral therapy is reported. This review provides an overview of the recent literature related to the etiology and treatment of BMS and identifies current challenges facing researchers and clinicians alike.
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Affiliation(s)
- A Ritchie
- 1 Department of Oral Pathology, Medicine and Radiology, School of Dentistry, Indiana University, Indianapolis, IN, USA
| | - J M Kramer
- 2 Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA.,3 Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
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