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Walker SP, Esterhuyse KGF, Van Lill L. The role of coping responses in the relationship between perceived stress and satisfaction with life amongst chronic pain patients. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2010.10872703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Trost Z, Parsons TD. Beyond Distraction: Virtual Reality Graded Exposure Therapy as Treatment for Pain-Related Fear and Disability in Chronic Pain. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/jabr.12021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zina Trost
- Department of Psychology; University of North Texas
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153
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Ramírez-Maestre C, Esteve R. The Role of Sex/Gender in the Experience of Pain: Resilience, Fear, and Acceptance as Central Variables in the Adjustment of Men and Women With Chronic Pain. THE JOURNAL OF PAIN 2014; 15:608-618.e1. [DOI: 10.1016/j.jpain.2014.02.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/09/2014] [Accepted: 02/19/2014] [Indexed: 12/26/2022]
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154
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Buruck G, Wendsche J, Melzer M, Strobel A, Dörfel D. Acute psychosocial stress and emotion regulation skills modulate empathic reactions to pain in others. Front Psychol 2014; 5:517. [PMID: 24910626 PMCID: PMC4039014 DOI: 10.3389/fpsyg.2014.00517] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/11/2014] [Indexed: 12/15/2022] Open
Abstract
Psychosocial stress affects resources for adequate coping with environmental demands. A crucial question in this context is the extent to which acute psychosocial stressors impact empathy and emotion regulation. In the present study, 120 participants were randomly assigned to a control group vs. a group confronted with the Trier Social Stress Test (TSST), an established paradigm for the induction of acute psychosocial stress. Empathy for pain as a specific subgroup of empathy was assessed via pain intensity ratings during a pain-picture task. Self-reported emotion regulation skills were measured as predictors using an established questionnaire. Stressed individuals scored significantly lower on the appraisal of pain pictures. A regression model was chosen to find variables that further predict the pain ratings. These findings implicate that acute psychosocial stress might impair empathic processes to observed pain in another person and the ability to accept one's emotion additionally predicts the empathic reaction. Furthermore, the ability to tolerate negative emotions modulated the relation between stress and pain judgments, and thus influenced core cognitive-affective functions relevant for coping with environmental challenges. In conclusion, our study emphasizes the necessity of reducing negative emotions in terms of empathic distress when confronted with pain of another person under psychosocial stress, in order to be able to retain pro-social behavior.
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Affiliation(s)
- Gabriele Buruck
- Work and Organizational Psychology, Department of Psychology, Technische Universität Dresden Dresden, Germany
| | - Johannes Wendsche
- Work and Organizational Psychology, Department of Psychology, Technische Universität Dresden Dresden, Germany
| | - Marlen Melzer
- Work and Organizational Psychology, Department of Psychology, Technische Universität Dresden Dresden, Germany
| | - Alexander Strobel
- Neurogenetics and Individual Differences, Department of Psychology, Technische Universität Dresden Dresden, Germany
| | - Denise Dörfel
- Work and Organizational Psychology, Department of Psychology, Technische Universität Dresden Dresden, Germany ; Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité Medical University Berlin Berlin, Germany
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Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic, disabling disease that can greatly compromise health-related quality of life (HRQoL). The aim of this study was to assess the impact of a 6-week twice/week Iyengar yoga program on HRQoL of young adults with RA compared with a usual-care waitlist control group. METHODS The program was designed to improve the primary outcome of HRQoL including pain and disability and psychological functioning in patients. Assessments were collected pretreatment, posttreatment, and at 2 months after treatment. Weekly ratings of anxiety, depression, pain, and sleep were also recorded. A total of 26 participants completed the intervention (yoga=11; usual-care waitlist=15). All participants were female (mean age=28 y). RESULTS Overall attrition was low at 15%. On average, women in the yoga group attended 96% of the yoga classes. No adverse events were reported. Relative to the usual-care waitlist, women assigned to the yoga program showed significantly greater improvement on standardized measures of HRQoL, pain disability, general health, mood, fatigue, acceptance of chronic pain, and self-efficacy regarding pain at posttreatment. Almost half of the yoga group reported clinically meaningful symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects showed improvements in HRQoL general health, pain disability, and weekly ratings of pain, anxiety, and depression were maintained at follow-up. CONCLUSIONS The findings suggest that a brief Iyengar yoga intervention is a feasible and safe adjunctive treatment for young people with RA, leading to HRQoL, pain disability, fatigue, and mood benefits. Moreover, improvements in quality of life, pain disability, and mood persisted at the 2-month follow-up.
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156
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Ramírez-Maestre C, Esteve R, López-Martínez A. Fear-Avoidance, Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain. Ann Behav Med 2014; 48:402-10. [PMID: 24722965 DOI: 10.1007/s12160-014-9619-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain,
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157
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Systematic Analyses of the Effects of Acceptance on Tolerance of Radiant Heat Pain. PSYCHOLOGICAL RECORD 2014. [DOI: 10.1007/s40732-014-0003-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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158
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Prins B, Decuypere A, Van Damme S. Effects of mindfulness and distraction on pain depend upon individual differences in pain catastrophizing: An experimental study. Eur J Pain 2014; 18:1307-15. [DOI: 10.1002/j.1532-2149.2014.491.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2014] [Indexed: 12/17/2022]
Affiliation(s)
- B. Prins
- Department of Experimental Clinical and Health Psychology; Ghent University; Belgium
| | - A. Decuypere
- Department of Experimental Clinical and Health Psychology; Ghent University; Belgium
| | - S. Van Damme
- Department of Experimental Clinical and Health Psychology; Ghent University; Belgium
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159
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The process of acceptance among rheumatoid arthritis patients in Switzerland: a qualitative study. Pain Res Manag 2014; 19:61-8. [PMID: 24527466 DOI: 10.1155/2014/168472] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, painful disease with many injurious psychological effects. Acceptance is an important component of pain management and is associated with improved quality of life, and lower levels of pain and depression. While studies have begun to identify the stages of acceptance, little is known about factors influencing the ease and speed with which patients pass through these stages. OBJECTIVE To explore the main stages through which RA patients pass and the strategies they adopt to learn to live with the pain, and to identify factors shaping patients' capacities to achieve acceptance. METHODS A qualitative study involving 20 semistructured interviews with RA patients in the Italian-speaking region of Switzerland was conducted. Analysis of the data followed the precepts of grounded theory. RESULTS Although the present study revealed that acceptance is not a smooth or linear process, five main stages in patients' struggles to accommodate the newly imposed limitations were, nonetheless, identified: naming the illness; realizing the illness; resisting the illness; 'hitting the bottom'; and integrating the illness. Diagnosis proved to be an especially tortuous stage in the case of RA, and the effects of delayed diagnosis continued to be felt during the subsequent stages. Patients' understanding of the notion of acceptance and the strategies that they used to achieve it were also explored. CONCLUSIONS Diagnosis of RA is notoriously difficult. Beyond the clinical difficulties, structural reasons for late diagnosis (symptoms being neglected by patients and medical professionals) were identifed. Delayed diagnosis hindered the acceptance process throughout, and led to more resistant behaviour and to a struggle to achieve the optimal formula for acceptance - accepting the losses of prepain life while still pursuing personal goals.
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Payne-Murphy JC, Beacham AO. Revisiting Chronic Pain Patient Profiling: An Acceptance-based Approach in an Online Sample. Clin Psychol Psychother 2014; 22:240-8. [DOI: 10.1002/cpp.1886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 12/22/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - Abbie O. Beacham
- Department of Psychology; Xavier University; Cincinnati OH 45207-6511 USA
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161
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Parsons TD, Trost Z. Virtual Reality Graded Exposure Therapy as Treatment for Pain-Related Fear and Disability in Chronic Pain. VIRTUAL, AUGMENTED REALITY AND SERIOUS GAMES FOR HEALTHCARE 1 2014. [DOI: 10.1007/978-3-642-54816-1_25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Acceptance, mindfulness, and cognitive reappraisal as longitudinal predictors of depression and quality of life in educators. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2014. [DOI: 10.1016/j.jcbs.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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163
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Taylor LEV, Stotts NA, Humphreys J, Treadwell MJ, Miaskowski C. A biopsychosocial-spiritual model of chronic pain in adults with sickle cell disease. Pain Manag Nurs 2013; 14:287-301. [PMID: 24315252 PMCID: PMC3857562 DOI: 10.1016/j.pmn.2011.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 06/04/2011] [Accepted: 06/06/2011] [Indexed: 01/30/2023]
Abstract
Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biologic, psychologic, sociologic, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model, biopsychosocial model for SCD pain, and Health Beliefs Model) have been published. The biopsychosocial multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. However, this model has not been applied to chronic pain associated with SCD. In addition, a spiritual/religious dimension is not included in this model. Because spirituality/religion is central to persons affected by SCD, that dimension needs to be added to any model of chronic pain in adults with SCD. In fact, data from one study suggest that spirituality/religiosity is associated with decreased pain intensity in adults with chronic pain from SCD. A biopsychosocial-spiritual model is proposed for adults with chronic pain from SCD, because it embraces the whole person. This model includes the biologic, psychologic, sociologic, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel's model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biologic, psychologic, sociologic, spiritual). The paper concludes with a discussion of implications for the use of this model in research.
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Affiliation(s)
- Lou Ella V Taylor
- Department of Physiological Nursing University of California, San Francisco.
| | - Nancy A Stotts
- Department of Physiological Nursing University of California, San Francisco
| | - Janice Humphreys
- Department of Family Health Care Nursing University of California, San Francisco
| | - Marsha J Treadwell
- Sickle Cell Center, Children's Hospital and Research Center, Oakland, California
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Abstract
OBJECTIVES The purpose of this qualitative metasynthesis is to articulate the knowledge gained from a review of qualitative studies of patients' experiences of chronic low back pain. METHODS Meta-ethnographic methodology guided the review of 33 articles representing 28 studies published in English in peer-reviewed journals between 2000 and 2012. A systematic comparison of the main themes from each study was conducted and 'synthesised' to create superordinate themes. RESULTS Three overarching interrelated themes were identified: the impact of chronic low back pain on self; relationships with significant others that incorporated two streams - health professionals and the organisation of care and relationships with family and friends; coping with chronic low back pain. Coping strategies were predominantly physical therapies, medication and avoidance behaviours with very few successful strategies reported. Professional and family support, self-efficacy, motivation, work conditions and exercise opportunities influenced pain experiences. Review authors' recommendations included psychological therapies, education, the facilitation of self-management strategies and support groups. DISCUSSION The review substantiates chronic low back pain as complex, dynamic and multidimensional, underpinned by experiences of persistent distressing pain, loss, and lowered self-worth, stigma, depression, premature aging, fear of the future. Future research should address the paucity of longitudinal studies, loss and issues of ethnicity, gender, ageing.
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165
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Graham CD, Weinman J, Sadjadi R, Chalder T, Petty R, Hanna MG, Turner C, Parton M, Maddison P, Radunovic A, Longman C, Robb Y, Bushby K, Hilton-Jones D, Rose MR. A multicentre postal survey investigating the contribution of illness perceptions, coping and optimism to quality of life and mood in adults with muscle disease. Clin Rehabil 2013; 28:508-19. [PMID: 24240060 DOI: 10.1177/0269215513511340] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To replicate the finding that illness perceptions influence quality of life in adults with muscle disease and to explore the additional influence of coping and optimism on quality of life and mood. DESIGN A postal survey including questionnaires recording quality of life, mood, illness perceptions, optimism, coping and functional impairment. SETTING National Health Service muscle clinics in the United Kingdom. PARTICIPANTS A convenience sample of adults with muscle disease. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Individualised Neuromuscular Quality of Life Questionnaire, Hospital Anxiety and Depression Scale. RESULTS A total of 226 completed questionnaires were returned. Although functional impairment explained most of the variance in three out of eight quality of life domains, psychological factors explained greater amounts of variance (between 19% and 52% of variance) in all other quality of life domains and in both mood domains (between 45% and 48% of variance). Overall, illness perceptions explained much of the variance in quality of life and mood score (between 5% and 37% of variance), while coping (up to 8% of variance) and optimism (up to 15% of variance) explained smaller amounts of variance. CONCLUSION The results confirm that illness perceptions are associated with quality of life in muscle disease and suggest that they also influence mood. The addition of optimism and coping variables into the analysis yielded small increases in the proportions of variance in quality of life and mood which were explained. These results have implications for the composition of future psychological interventions.
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Affiliation(s)
- Christopher D Graham
- 1Department of Psychology, Institute of Psychiatry, King's College London, London, UK
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166
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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167
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Elander J. A review of evidence about behavioural and psychological aspects of chronic joint pain among people with haemophilia. Haemophilia 2013; 20:168-75. [DOI: 10.1111/hae.12291] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2013] [Indexed: 01/31/2023]
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Elander J, Duarte J, Maratos FA, Gilbert P. Predictors of painkiller dependence among people with pain in the general population. PAIN MEDICINE 2013; 15:613-24. [PMID: 24152117 DOI: 10.1111/pme.12263] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Self-medication with painkillers is widespread and increasing, and evidence about influences on painkiller dependence is needed to inform efforts to prevent and treat problem painkiller use. DESIGN Online questionnaire survey. PARTICIPANTS People in the general population who had pain and used painkillers in the last month (N = 112). MEASUREMENTS Pain frequency and intensity, use of over-the-counter and prescription painkillers, risk of substance abuse (Screener and Opioid Assessment for Patients with Pain [SOAPP] scale), depression, anxiety, stress, alexithymia, pain catastrophizing, pain anxiety, pain self-efficacy, pain acceptance, mindfulness, self-compassion, and painkiller dependence (Leeds Dependence Questionnaire). RESULTS In multiple regression, the independent predictors of painkiller dependence were prescription painkiller use (β 0.21), SOAPP score (β 0.31), and pain acceptance (β -0.29). Prescription painkiller use mediated the influence of pain intensity. Alexithymia, anxiety, and pain acceptance all moderated the influence of pain. CONCLUSIONS The people most at risk of developing painkiller dependence are those who use prescription painkillers more frequently, who have a prior history of substance-related problems more generally, and who are less accepting of pain. Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence: 1) pain leading to painkiller use, 2) risk factors for substance-related problems irrespective of pain, and 3) psychological factors related to pain. The model could guide further research among the general population and high-risk groups, and acceptance-based interventions could be adapted and evaluated as methods to prevent and treat painkiller dependence.
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169
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Pinto-Gouveia J, Costa J, Marôco J. The first 2 years of rheumatoid arthritis: The influence of acceptance on pain, physical limitation and depression. J Health Psychol 2013; 20:102-12. [DOI: 10.1177/1359105313499807] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The influence of acceptance in the progression of pain, physical limitation and depression was explored in the first 2 years of rheumatoid arthritis. Latent growth curve models showed significant increases in pain, physical limitation and depression. Besides that, the levels of pain and physical limitation at the baseline were associated with acceptance but not its progression across time. Therefore, patients with higher scores of acceptance reported less pain and physical limitation. The progression of depression was associated with acceptance; higher acceptance patients had slower growth rates of depression across time, even when pain and physical limitations increased. The inclusion of pain acceptance in clinical practice is discussed.
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170
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Kratz AL, Hirsh AT, Ehde DM, Jensen MP. Acceptance of pain in neurological disorders: associations with functioning and psychosocial well-being. Rehabil Psychol 2013; 58:1-9. [PMID: 23437995 DOI: 10.1037/a0031727] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Chronic pain acceptance has been shown to be related to positive adjustment to chronic pain in patients presenting with pain as a primary problem. However, the role of pain acceptance in adjustment to chronic pain secondary to a neurological disorder that is often associated with physical disability has not been determined. The purpose of this study was to examine whether two domains of chronic pain acceptance--activity engagement and pain willingness--predict adjustment to pain, controlling for pain intensity and key demographic and clinical variables in individuals with muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), or spinal cord injury (SCI). METHOD Participants were 508 community-dwelling adults with a diagnosis of MD, MS, PPS, or SCI who also endorsed a chronic pain problem. Participants completed self-report measures of pain acceptance, quality of life, pain interference, pain intensity, depression, and social role satisfaction. RESULTS Hierarchical linear regressions indicated that activity engagement predicted lower pain interference and depression, and greater quality of life and social role satisfaction. Pain willingness predicted less pain interference and depression. Together, the two pain acceptance subscales accounted for more variance in outcomes than did self-reported pain intensity. CONCLUSIONS Findings correspond with the broader pain acceptance literature, although activity engagement appears to be a more robust predictor of adjustment than does pain willingness. This research supports the need for future studies to determine the extent to which treatments that increase acceptance result in positive outcomes in persons with chronic pain secondary to neurological disorders.
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109-2800, USA.
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Chordas C, Manley P, Merport Modest A, Chen B, Liptak C, Recklitis CJ. Screening for pain in pediatric brain tumor survivors using the pain thermometer. J Pediatr Oncol Nurs 2013; 30:249-59. [PMID: 23867966 DOI: 10.1177/1043454213493507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Numerous instruments have been developed to measure pain within various populations; however, there remains limited understanding of how these tools are applicable to childhood cancer survivors. This study compared a single-item screening measure, the Pain Thermometer (PT), with a more in-depth measure, the Brief Pain Survey (BPS), in a cohort of childhood brain tumor survivors. Ninety-nine survivors (aged 13-32 years) with a median time from diagnosis of 9.9 years (range = 2-18 years) completed the 2 instruments. Thirty-seven survivors (37.4%) were identified on the BPS as having clinically significant pain, but the PT was not found to be an accurate tool for identifying these pain cases. Application of receiver operating characteristic curve analysis of PT ratings against BPS criterion indicated overall concordance between measures. No cutoff score on the PT were identified that resulted in acceptable sensitivity, meaning pain cases identified on the BPS would be missed on the PT. Findings suggest that a multi-item screening measure may better identify clinically significant pain in childhood brain tumor survivors compared with a 1-item screening measure alone.
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172
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Buhrman M, Skoglund A, Husell J, Bergström K, Gordh T, Hursti T, Bendelin N, Furmark T, Andersson G. Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial. Behav Res Ther 2013; 51:307-15. [DOI: 10.1016/j.brat.2013.02.010] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 02/02/2013] [Accepted: 02/12/2013] [Indexed: 11/26/2022]
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Weise C, Kleinstäuber M, Hesser H, Westin VZ, Andersson G. Acceptance of tinnitus: validation of the tinnitus acceptance questionnaire. Cogn Behav Ther 2013; 42:100-15. [PMID: 23627873 DOI: 10.1080/16506073.2013.781670] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The concept of acceptance has recently received growing attention within tinnitus research due to the fact that tinnitus acceptance is one of the major targets of psychotherapeutic treatments. Accordingly, acceptance-based treatments will most likely be increasingly offered to tinnitus patients and assessments of acceptance-related behaviours will thus be needed. The current study investigated the factorial structure of the Tinnitus Acceptance Questionnaire (TAQ) and the role of tinnitus acceptance as mediating link between sound perception (i.e. subjective loudness of tinnitus) and tinnitus distress. In total, 424 patients with chronic tinnitus completed the TAQ and validated measures of tinnitus distress, anxiety, and depression online. Confirmatory factor analysis provided support to a good fit of the data to the hypothesised bifactor model (root-mean-square-error of approximation = .065; Comparative Fit Index = .974; Tucker-Lewis Index = .958; standardised root mean square residual = .032). In addition, mediation analysis, using a non-parametric joint coefficient approach, revealed that tinnitus-specific acceptance partially mediated the relation between subjective tinnitus loudness and tinnitus distress (path ab = 5.96; 95% CI: 4.49, 7.69). In a multiple mediator model, tinnitus acceptance had a significantly stronger indirect effect than anxiety. The results confirm the factorial structure of the TAQ and suggest the importance of a general acceptance factor that contributes important unique variance beyond that of the first-order factors activity engagement and tinnitus suppression. Tinnitus acceptance as measured with the TAQ is proposed to be a key construct in tinnitus research and should be further implemented into treatment concepts to reduce tinnitus distress.
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Affiliation(s)
- Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Germany.
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174
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Sil S, Kashikar-Zuck S. Understanding why cognitive-behavioral therapy is an effective treatment for adolescents with juvenile fibromyalgia. ACTA ACUST UNITED AC 2013; 8. [PMID: 24416078 DOI: 10.2217/ijr.13.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent studies have demonstrated that cognitive-behavioral therapy (CBT) is an effective treatment for children and adolescents with juvenile fibromyalgia. Unfortunately, the specific psychological changes that occur during treatment that explain why CBT works are not well understood. Historically, the increased use of specific coping strategies learned during CBT was thought to be the primary reason for why CBT was effective. However, evidence to support the notion that increases in adaptive coping directly lead to patient improvement is minimal. Instead, a growing number of studies in adults suggest that CBT results in more global changes of psychological perceptions of the pain itself (cognitive appraisals) and one's ability to manage the pain. This report discusses the role of coping and aspects of cognitive appraisal as potential psychological changes that explain CBT-related improvements for youths with juvenile fibromyalgia.
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Affiliation(s)
- Soumitri Sil
- Division of Behavioral Medicine & Clinical Psychology, Cincinnat Children's Hospital Medical Center, Cincinnat, OH 45229, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnat Children's Hospital Medical Center, Cincinnat, OH 45229, USA ; Department of Pediatrics, University of Cincinnat College of Medicine, Cincinnat, OH, USA
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175
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Snelgrove S, Edwards S, Liossi C. A longitudinal study of patients’ experiences of chronic low back pain using interpretative phenomenological analysis: Changes and consistencies. Psychol Health 2013; 28:121-38. [DOI: 10.1080/08870446.2011.630734] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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176
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Helminen EE, Sinikallio SH, Valjakka AL, Väisänen-Rouvali RH, Arokoski JP. Effectiveness of a cognitive-behavioral group intervention for knee osteoarthritis pain: protocol of a randomized controlled trial. BMC Musculoskelet Disord 2013; 14:46. [PMID: 23356455 PMCID: PMC3626912 DOI: 10.1186/1471-2474-14-46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/24/2013] [Indexed: 12/17/2022] Open
Abstract
Background Knee osteoarthritis is the most common type of arthritis, with pain being its most common symptom. Little is known about the psychological aspects of knee osteoarthritis pain. There is an emerging consensus among osteoarthritis specialists about the importance of addressing not only biological but also psychosocial factors in the assessment and treatment of osteoarthritis. As few studies have evaluated the effect of psychological interventions on knee osteoarthritis pain, good quality randomized controlled trials are needed to determine their effectiveness. Methods/Design We intend to conduct a 6-week single-blinded randomized controlled trial with a 12-month follow-up. Altogether, 108 patients aged from 35 to 75 years with clinical symptoms and radiographic grading (KL 2–4) of knee osteoarthritis will be included. The clinical inclusion criteria are pain within the last year in or around the knee occurring on most days for at least one month, and knee pain of ≥40 mm on a 100-mm visual analogue scale in the WOMAC pain subscale for one week prior to study entry. Patients with any severe psychiatric disorder, other back or lower limb pain symptoms more aggravating than knee pain, or previous or planned lower extremity joint surgery will be excluded. The patients will be randomly assigned to a combined GP care and cognitive-behavioral intervention group (n = 54) or to a GP care control group (n = 54). The cognitive-behavioral intervention will consist of 6 weekly group sessions supervised by a psychologist and a physiotherapist experienced in the treatment of pain. The main goals of the intervention are to reduce maladaptive pain coping and to increase the self-management of pain and disability. The follow-up-points will be arranged at 3 and 12 months. The primary outcome measure will be the WOMAC pain subscale. Secondary outcome measures will include self-reports of pain and physical function, a health related quality of life questionnaire, and various psychological questionnaires. Personnel responsible of the data analysis will be blinded. Discussion This study addresses the current topic of non-pharmacological conservative treatment of knee OA-related pain. We anticipate that these results will provide important new insights to the current care recommendations. Trial registration Current Controlled Trials ISRCTN64794760
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Affiliation(s)
- Eeva-Eerika Helminen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, P.O.B 1777 Kuopio, FI-70211, Finland.
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177
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O’Hagan FT, Coutu MF, Baril R. A case of mistaken identity? The role of injury representations in chronic musculoskeletal pain. Disabil Rehabil 2013; 35:1552-63. [DOI: 10.3109/09638288.2012.748835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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178
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Perceived injustice moderates the relationship between pain and depressive symptoms among individuals with persistent musculoskeletal pain. Pain Res Manag 2012; 17:335-40. [PMID: 23061084 DOI: 10.1155/2012/501260] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Numerous investigations report that depressive symptoms frequently coexist with persistent pain. However, evidence suggests that symptoms of depression are not an inevitable consequence of pain. Diathesis-stress formulations suggest that psychological factors interact with the stress of pain to heighten the risk of depressive symptoms. Perceptions of injustice have recently emerged as a factor that may interact with the stress of pain to increase depressive symptoms. OBJECTIVES The purpose of the present study was to examine whether perceived injustice moderates the relationship between pain and depressive symptoms. METHODS A total of 107 individuals with persistent musculoskeletal pain completed self-report measures of pain severity, depressive symptoms, perceived injustice and catastrophizing. RESULTS A hierarchical regression analysis revealed that the interaction between pain severity and perceived injustice uniquely contributed an additional 6% of the variance to the prediction of depressive symptoms, beyond the main effects of these variables. Post hoc probing indicated that pain was significantly related to depressive symptoms at high, but not low levels of perceived injustice. This finding remained statistically significant even when controlling for pain catastrophizing. CONCLUSIONS The results suggest that perceived injustice augments the relationship between pain severity and depressive symptoms. The inclusion of techniques specifically targeting perceptions of injustice may enhance the effectiveness of interventions aimed at reducing symptoms of depression for individuals presenting with strong perceptions of injustice.
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179
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Henwood P, Ellis J, Logan J, Dubouloz CJ, D'Eon J. Acceptance of Chronic Neuropathic Pain in Spinal Cord Injured Persons: A Qualitative Approach. Pain Manag Nurs 2012; 13:215-22. [DOI: 10.1016/j.pmn.2010.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 05/03/2010] [Accepted: 05/10/2010] [Indexed: 11/24/2022]
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180
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Gillanders DT, Ferreira NB, Bose S, Esrich T. The relationship between acceptance, catastrophizing and illness representations in chronic pain. Eur J Pain 2012; 17:893-902. [PMID: 23169693 DOI: 10.1002/j.1532-2149.2012.00248.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cognitive- and acceptance-based approaches are used to help people live with chronic pain. Little is known about how these constructs relate to each other. In this study, we examined how cognitive representations of chronic pain relate to interpersonal styles such as catastrophizing and the behavioural process of acceptance of chronic pain. This study further examined how these processes relate to emotional and physical functioning in chronic pain. METHODS A cross-sectional design, employing validated questionnaires, was used to measure pain, emotional and physical dysfunction, illness representations, catastrophizing and acceptance in a heterogeneous sample of 150 chronic pain sufferers. RESULTS The psychological variables significantly mediated the impact of pain severity on both emotional and physical dysfunction. In addition, a distinct pattern of mediation was observed. The relationship between pain and emotional dysfunction was mediated by representations of pain as a highly emotive experience and by catastrophizing; acceptance did not mediate this relationship. By contrast, the relationship between pain and physical dysfunction was mediated by acceptance and representations of high consequences of chronic pain, but not by catastrophizing. CONCLUSIONS Pain severity itself is a relatively poor predictor of emotional and physical dysfunction in chronic pain states. These relationships are significantly mediated by psychological variables. Different approaches to chronic pain rehabilitation emphasize different targets (changing illness representations and reducing catastrophizing vs. acceptance and behavioural activation). This cross-sectional study suggests that these processes may differentially influence outcomes, but that they are complex and overlapping. Theoretical and clinical implications are discussed.
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Affiliation(s)
- D T Gillanders
- University of Edinburgh/NHS Lothian Chronic Pain Service, UK.
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181
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Taylor J, Huelbes S, Albu S, Gómez-Soriano J, Peñacoba C, Poole HM. Neuropathic Pain Intensity, Unpleasantness, Coping Strategies, and Psychosocial Factors after Spinal Cord Injury: An Exploratory Longitudinal Study During the First Year. PAIN MEDICINE 2012; 13:1457-68. [DOI: 10.1111/j.1526-4637.2012.01483.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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182
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Wicksell RK, Kemani M, Jensen K, Kosek E, Kadetoff D, Sorjonen K, Ingvar M, Olsson GL. Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial. Eur J Pain 2012; 17:599-611. [DOI: 10.1002/j.1532-2149.2012.00224.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | - K. Sorjonen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm; Sweden
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183
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Gauntlett-Gilbert J, Connell H, Clinch J, McCracken LM. Acceptance and values-based treatment of adolescents with chronic pain: outcomes and their relationship to acceptance. J Pediatr Psychol 2012; 38:72-81. [PMID: 23071352 DOI: 10.1093/jpepsy/jss098] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Psychological treatments for pediatric chronic pain are moderately effective. However, there have been few studies of the psychological processes associated with treatment response. This study examines the effects of Acceptance and Commitment Therapy (ACT) treatment on a severely disabled group of adolescents with chronic pain, examining relationships between outcome and acceptance. METHODS 98 adolescents with pain, mean age 15.6 years, underwent an uncontrolled trial of 3-week residential ACT treatment. RESULTS Adolescents improved in self-reported functioning and objective physical performance at 3-month follow-up. They were less anxious and catastrophic, attended school more regularly, and used health care facilities less often. Most positive treatment outcomes were associated with improvements in acceptance. CONCLUSIONS An intensive ACT-based pain rehabilitation course was an effective treatment for disabled adolescents with chronic pain. Its results were theoretically consistent--improvements were associated with changes in acceptance and were achieved without pain control or cognitive restructuring techniques.
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Affiliation(s)
- Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Bath, BA1 1RL, UK.
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184
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la Cour P. The clinical pain acceptance Q-sort: A tool for assessment and facilitation of pain acceptance. PSYCHOL HEALTH MED 2012; 17:611-20. [DOI: 10.1080/13548506.2011.648646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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185
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Jordan KP, Sim J, Moore A, Bernard M, Richardson J. Distinctiveness of long-term pain that does not interfere with life: an observational cohort study. Eur J Pain 2012; 16:1185-94. [PMID: 22887341 PMCID: PMC3443361 DOI: 10.1002/j.1532-2149.2012.00118.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reporting of pain that does not interfere with life is common in the older population but little is known about people with such long-term non-interfering pain. OBJECTIVES To assess whether non-interfering pain can be a long-term state, and to compare this group with those who continuously report no pain, and with those with chronic pain that interferes with life. METHODS This was a prospective general population cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 plus were sent baseline, 3-year and 6-year questionnaires. Those who reported the same pain status (no pain, non-interfering pain, interfering pain) at each time point were compared on pain intensity, widespread pain and medication, and on sociodemographic and co-morbid characteristics at 6 years. RESULTS Forty percent of responders reported the same pain status at each time point; 12% reported long-term non-interfering pain. Fifty-nine percent of those with non-interfering pain reported at least one site of high pain intensity, 33% reported widespread pain, and 90% had used pain medication in the past 4 weeks. This group was similar to the no-pain group but distinct on sociodemographic and co-morbid measures from those with pain that interfered. CONCLUSIONS Long-term non-interfering pain is common, but despite often suffering from high pain intensity and widespread pain, those within this group seem to be able to control their pain without allowing it to affect their everyday lives. Future work is needed to assess how people with long-term pain ensure it does not cause interference with life.
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Affiliation(s)
- K P Jordan
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, UK.
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186
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Cho S, McCracken LM, Heiby EM, Moon DE, Lee JH. Pain acceptance-based coping in complex regional pain syndrome Type I: daily relations with pain intensity, activity, and mood. J Behav Med 2012; 36:531-8. [PMID: 22854886 DOI: 10.1007/s10865-012-9448-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 07/24/2012] [Indexed: 11/26/2022]
Abstract
This study aimed to examine the temporal patterning of pain acceptance-based coping, activity, and mood in patients with complex regional pain syndrome Type I (CRPS-I), by using a daily diary method. A total of 30 patients with CRPS-I seeking treatment in a tertiary pain management center located in Seoul, Korea participated in the study. Multilevel random effects analyses indicated that (a) engagement in pain acceptance-based coping was significantly associated with lower same-day pain and negative mood and greater same-day activity and positive mood; (b) pain acceptance-based coping predicted increases in activity on the following day; (c) greater pain intensity was significantly associated with lower same-day pain acceptance-based coping and activity and greater same-day negative mood; and (d) pain intensity did not predict pain acceptance-based coping, activity, or mood on the following day. These findings suggest that patients with CRPS-I may benefit from responding to pain with acceptance. Further study and eventual application of this process in CRPS-I may improve upon the success of current approaches to this problem.
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Affiliation(s)
- Sungkun Cho
- Department of Psychology, Chung-Ang University, 221 Heukseok-dong, Dongjak-gu, Seoul, 156-756, Korea.
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187
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Ojala T, Piirainen A, Sipilä K, Suutama T, Häkkinen A. Reliability and validity study of the Finnish version of the Chronic Pain Acceptance Questionnaire (CPAQ). Disabil Rehabil 2012; 35:306-14. [DOI: 10.3109/09638288.2012.694572] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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188
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Andrews NE, Strong J, Meredith PJ. Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2012; 93:2109-2121.e7. [PMID: 22728699 DOI: 10.1016/j.apmr.2012.05.029] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/19/2012] [Accepted: 05/08/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To systematically review the associations between different approaches to activity (ie, activity pacing, avoidance, or endurance) and indicators of patient functioning in chronic pain samples. DATA SOURCES A key word search was conducted in PsycINFO, MEDLINE via Ovid, EMBASE, and PubMed up to March 2011. STUDY SELECTION To be included, studies had to (1) be written in English, (2) report on an adult chronic pain sample, and (3) report a correlation coefficient between at least 1 measure of 1 of the 3 "approach to activity" variables and an indicator of patient functioning. DATA EXTRACTION Two reviewers independently screened abstracts and full-text articles for eligibility and extracted the data. Results of correlation analyses were grouped on the basis of measure of approach to activity (pacing/avoidance/endurance) and the criterion variable measured (pain/physical functioning/psychological functioning), resulting in 9 categories. Random-effects modeling was then used to pool data across studies in each category. DATA SYNTHESIS Forty-one studies were eligible for inclusion. Results demonstrated that avoidance of activity was consistently associated with more pain, poorer psychological functioning, and more physical disability. While enduring with activity was associated with enhanced physical and psychological functioning, these relationships appeared to be dependent on the measure used, with measures more reflective of persisting with activities to the point of severe pain aggravation (overactivity) linked to poorer outcomes. Pacing was generally linked to better psychological functioning but more pain and disability. CONCLUSIONS Although causation cannot be determined, results of this study suggest that both avoidance of activity and overactivity are associated with poorer patient outcomes. Unexpected results relating to pacing may reflect either the ineffectiveness of pacing if not used to gradually increase an individual's activity level or the notion that individuals with better psychological functioning but more pain and disability are more inclined to pace activity.
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Affiliation(s)
- Nicole E Andrews
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia.
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189
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Pakenham KI, Samios C. Couples coping with multiple sclerosis: a dyadic perspective on the roles of mindfulness and acceptance. J Behav Med 2012; 36:389-400. [PMID: 22689212 DOI: 10.1007/s10865-012-9434-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 05/26/2012] [Indexed: 11/27/2022]
Abstract
This study investigated the roles of mindfulness and acceptance on adjustment in couples coping with multiple sclerosis (MS) by examining the effects of an individual's mindfulness and acceptance on their own adjustment (actor effects) and the effects of their partner's mindfulness and acceptance on their adjustment (partner effects) using the Actor-Partner Interdependence Model. The study was a cross-sectional standard dyadic design that collected data from couples coping with MS. Sixty-nine couples completed measures of mindfulness, acceptance and adjustment (depression, anxiety, life satisfaction, positive affect and relationship satisfaction). As hypothesised there were actor effects of mindfulness and acceptance on better adjustment, however, the beneficial actor effects of mindfulness were only evident on depression and anxiety. The actor effects of both mindfulness and acceptance on relationship satisfaction were moderated by MS status. Regarding partner effects, there was support for the beneficial impact of acceptance on partner relationship satisfaction. In addition, the partner effect of acceptance moderated the actor effect of acceptance on depression, such that the actor effect on lower depression was weaker when the partner reported high acceptance. Findings support the roles of mindfulness and acceptance in shaping individual and dyadic adjustment in couples coping with chronic illness.
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Affiliation(s)
- Kenneth I Pakenham
- School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia.
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190
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Gauchet A, Shankland R, Dantzer C, Pelissier S, Aguerre C. Applications cliniques en psychologie de la santé. PSYCHOLOGIE FRANCAISE 2012. [DOI: 10.1016/j.psfr.2012.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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191
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Attention to pain and fear of pain in patients with chronic pain. J Behav Med 2012; 36:371-8. [PMID: 22614260 DOI: 10.1007/s10865-012-9433-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
To investigate how acceptance of illness affects chronic pain in terms of attention towards pain and fearful thinking of pain. 62 participants (50 women) with chronic pain carried a palmtop computer for 2 weeks. Eight times each day auditory signals were delivered to cue participants to complete questions about their experience. Multilevel analyses indicated that on moments with more intense pain, more fearful thinking about pain, and less positive emotions, attention to pain was increased. Illness acceptance did not moderate the relation between pain intensity and attention to pain. Results further indicated that on moments with more intense pain, more negative emotions, and less positive emotions, fearful thinking about pain was increased. Of particular interest was the finding that the relationship between pain intensity and fearful thinking about pain was less strong for those high in acceptance. Pain captures attention and elicits fearful thinking about pain. Acceptance may be a useful avenue to lower negative thinking about pain, and to increase well-being in patients with chronic illnesses.
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192
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Gebler F, Maercker A. Integration einer existenziellen Perspektive in ein kognitiv-behaviorales Schmerzbewältigungsprogramm. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2012. [DOI: 10.1026/1616-3443/a000136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: In der vorliegenden Studie wird das Einbeziehen einer existenziellen Perspektive in ein kognitiv-behaviorales Schmerzbewältigungsprogramm empirisch überprüft. Die existenzielle Perspektive hat einen akkommodativen Schwerpunkt im Gegensatz zum assimilativen Fokus herkömmlicher Programme. Hypothesen: Beide Behandlungsgruppen sollten im Prä-Post-Vergleich eine signifikant geringere schmerzbedingte Behinderung als auch eine signifikant höhere Lebensqualität aufweisen. Die Experimentalgruppe sollte darüber hinaus einen signifikant höheren Therapieerfolg als die Kontrollgruppe aufweisen. Methode: 149 Patienten mit chronischen Schmerzen nahmen im Rahmen eines interdisziplinären Klinikaufenthaltes entweder an einer rein kognitiv-behavioralen Schmerzbewältigungsgruppe (n = 70) oder an einem existenziell ergänzten Gruppenprogramm (n = 79) teil. Die Auswertung der Prä-Post-Vergleiche erfolgte mit einer MANOVA mit Messwiederholung sowie nachfolgenden zweifaktoriellen Varianzanalysen mit Messwiederholung. Ergebnisse: Beide Behandlungsgruppen zeigen signifikante Verbesserungen bei großen Effektstärken. Die Experimentalgruppe zeigt darüber hinaus einen signifikant höheren Therapieerfolg hinsichtlich schmerzbedingter Behinderung bei kleiner Effektgröße. Weiterhin ergaben sich ein differenzieller Effekt für die Personen mit niedrigerem Ausbildungsgrad sowie höhere Zufriedenheitswerte für die existenzielle Intervention. Schlussfolgerung: Die Ergebnisse zeigen, dass auch im Rahmen eines umfassenden stationären Klinikaufenthaltes die Implementierung einer existenziellen Intervention einen bedeutsamen zusätzlichen Effekt haben kann. Dies scheint insbesondere für die große Gruppe der Patienten mit formal niedrigerem Ausbildungsgrad zu gelten.
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193
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Abstract
Headache in children and adolescents represents a number of complex and multifaceted pain syndromes that can benefit from psychological intervention. There is good evidence for the efficacy of cognitive behavioral therapy, relaxation training, and biofeedback. The choice of intervention is influenced by patients' age, sex, family and cultural background, as well as the nature of stressors and comorbid psychiatric symptoms. Management must always be family-centered. Psychological treatments are essential elements of the multidisciplinary, biopsychosocial management of primary headache disorders, particularly for those with frequent or chronic headache, a high level of headache-related disability, medication overuse, or comorbid psychiatric symptoms. Future studies of efficacy and effectiveness of psychological treatment should use the International Headache Society's definition and classification of headache disorders, and stratify results by headache type, associated conditions, and treatment modality.
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194
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Cardosa M, Osman ZJ, Nicholas M, Tonkin L, Williams A, Abd Aziz K, Mohd Ali R, Dahari NM. Self-management of chronic pain in Malaysian patients: effectiveness trial with 1-year follow-up. Transl Behav Med 2012; 2:30-37. [PMID: 22448204 PMCID: PMC3291846 DOI: 10.1007/s13142-011-0095-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Self-management of chronic illnesses has been widely recognised as an important goal on quality of life, health service utilisation and cost grounds. This study describes the first published account on the application of this approach to people suffering from chronic pain conditions in a Southeast Asian country, Malaysia. A heterogeneous sample of chronic pain patients in Malaysia attended a 2-week cognitive-behavioural pain management programme (PMP) aimed at improving daily functional activities and general psychological well-being. Complete datasets from 70 patients out of 102 patients who attended 11 programmes conducted from 2002 to 2007, as well as the 1-month and 1-year follow-up sessions at the hospital clinic, are reported. The pre- to post-treatment results on self-report measures indicate that significant gains were achieved on the dimensions of pain, disability and psychological well-being. These gains were maintained at both 1-month and 1-year follow-ups. The results mirror those reported from similar interventions in Europe and North America and indicate the concept of self-management of a chronic illness is acceptable and meaningful to Asian patients. Importantly, the achieved outcomes were independent of gender and ethnic group status.
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Affiliation(s)
| | - Zubaidah Jamil Osman
- Department of Psychiatry, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Michael Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| | - Lois Tonkin
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
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195
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Roth RS, Geisser ME, Williams DA. Interventional pain medicine: retreat from the biopsychosocial model of pain. Transl Behav Med 2012; 2:106-16. [PMID: 24073101 PMCID: PMC3717820 DOI: 10.1007/s13142-011-0090-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The field of pain medicine has shifted from multidisciplinary rehabilitation to procedure-focused interventional pain medicine (IPM). Considerable controversy exists regarding the efficacy of IPM and its more narrow focus on nociception as an exclusive target of pain treatment. This topical review aims to examine pain research and treatment outcome studies that support a biopsychosocial model of pain, and to critique the clinical practice of IPM given its departure from the premises of a biopsychosocial model. A modern definition of pain and findings from clinical and basic science studies indicate that pain-related psychological factors are integral to pain perception. The clinical viability of IPM is challenged based upon its biomedical view of peripheral nociception as a primary source of pain and the potential of this viewpoint to foster maladaptive pain attributions and discourage the use of pain coping strategies among chronic pain patients. IPM should adopt a biopsychosocial perspective on pain and operate within a framework of multidisciplinary pain rehabilitation to improve its effectiveness.
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Affiliation(s)
- Randy S Roth
- />Department of Physical Medicine & Rehabilitation, University of Michigan Health System, 325 E. Eisenhower Pkwy, Ann Arbor, MI 48108 USA
- />Department of Physical Medicine & Rehabilitation, Ann Arbor Veterans Health Care System, Ann Arbor, MI 48105 USA
| | - Michael E Geisser
- />Department of Physical Medicine & Rehabilitation, University of Michigan Health System, 325 E. Eisenhower Pkwy, Ann Arbor, MI 48108 USA
| | - David A Williams
- />Chronic Pain and Fatigue Research Center, University of Michigan Health System, Ann Arbor, MI 48109 USA
- />Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI USA
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196
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Perry Y, Henry JD, Nangle MR, Grisham JR. Regulation of negative affect in schizophrenia: the effectiveness of acceptance versus reappraisal and suppression. J Clin Exp Neuropsychol 2012; 34:497-508. [PMID: 22348246 DOI: 10.1080/13803395.2012.661405] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although general emotion coping difficulties are well documented in schizophrenia, there has been limited study of specific regulatory strategies such as suppression, reappraisal, and acceptance. In the present study, clinical and control participants were asked to watch video clips selected to elicit negative affect while engaging in one of these three different emotion regulation strategies (counterbalanced), versus a passive viewing condition. The experiential and expressive components of emotion were quantified using self-report and facial electromyography, respectively. A major finding was that, in contrast to control participants, individuals with schizophrenia did not report a greater willingness to reexperience negative emotion after engaging in acceptance. These data are discussed in the context of evidence highlighting the potentially important role of acceptance in understanding affective abnormalities in clinical conditions such as schizophrenia.
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Affiliation(s)
- Yael Perry
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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197
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Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE To analyze the relationship between resilience, acceptance, coping, and adjustment to spinal chronic pain. SUMMARY OF BACKGROUND DATA Several studies have concluded that resilience is relevant in predicting pain and physical functioning among patients with chronic pain. Although resilience may have a role in preventing or living with chronic pain, there is little research on the effects of resilience on adjustment among patients with chronic pain. METHODS Multivariate multiple regression by structural equation modeling was performed to simultaneously determine the influence of all the predictor variables on all the dependent variables. The sample was composed of 299 patients (138 men and 161 women) suffering from chronic spinal pain. : Higher levels of resilience were associated with higher levels of pain acceptance and active coping strategies. Active coping and acceptance were associated with higher levels of adjustment to pain. CONCLUSION Positive personality characteristics could play a crucial role in patient adjustment, and thus clinicians should take into account the positive path to capacity to better understand the chronic pain experience.
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198
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Schoth DE, Nunes VD, Liossi C. Attentional bias towards pain-related information in chronic pain; a meta-analysis of visual-probe investigations. Clin Psychol Rev 2012; 32:13-25. [DOI: 10.1016/j.cpr.2011.09.004] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 07/18/2011] [Accepted: 09/10/2011] [Indexed: 01/07/2023]
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199
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Englbrecht M, Gossec L, DeLongis A, Scholte-Voshaar M, Sokka T, Kvien TK, Schett G. The Impact of Coping Strategies on Mental and Physical Well-Being in Patients with Rheumatoid Arthritis. Semin Arthritis Rheum 2012; 41:545-55. [DOI: 10.1016/j.semarthrit.2011.07.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 07/28/2011] [Accepted: 07/28/2011] [Indexed: 12/23/2022]
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200
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Toye F, Barker K. 'I can't see any reason for stopping doing anything, but I might have to do it differently'--restoring hope to patients with persistent non-specific low back pain--a qualitative study. Disabil Rehabil 2012; 34:894-903. [PMID: 22296289 DOI: 10.3109/09638288.2011.626483] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore the differences in narrative between patients with persistent non-specific low back pain (PLBP) who benefited from a pain management programme, and those who did not benefit. METHOD We conducted interviews with 20 patients attending a pain management programme; prior to attending the programme, immediately following the programme and at one year. Our analysis focused on a theoretical sample of patients who either described dramatic life improvements at one year, and who described themselves as much worse. We used the methods of grounded theory. RESULTS We found that finding hope was central to good outcome. Patients restored hope by making certain changes; (a) deconstructing specific fears, (b) constructing an acceptable explanatory model (c) reconstructing self identity by making acceptable changes. Those who had not restored hope retained fears of loss of self, remained committed to the biomedical model and were unable to make acceptable changes. CONCLUSIONS Our findings may help to operationalise the restoration of hope in patients with PLBP. Firstly, health care professionals need to identify and resolve any specific fears of movement. Secondly, patients need an acceptable explanatory model that fits their experience and personal narrative. Finally our study confirms the centrality of self concept to recovery.
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Affiliation(s)
- Francine Toye
- Physiotherapy Research Unit, Nuffield Orthopedic Centre, Oxford, United Kingdom.
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