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Lojacono M, McClenahan BJ, Borgehammar JS, Young JL, Schenk RJ, Rhon DI. Associations between smoking history, baseline pain interference and symptom distribution, and physical function at discharge, in individuals seeking care for musculoskeletal pain. Addict Behav 2024; 158:108133. [PMID: 39163696 DOI: 10.1016/j.addbeh.2024.108133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/13/2024] [Accepted: 08/12/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVE Study of the association between smoking and pain intensity has produced conflicting results; with less focus on pain interference. Different pain constructs could have varying associations with smoking behaviors. This study sought to investigate the association between smoking history and not only pain intensity, but also pain interference, symptom distribution and physical function. METHODS Smoking history (current, past, or none), pain interference (Pain, Enjoyment of Life, and General Activity scale), symptom distribution and physical function scores were extracted from medical records of patients seen in physical therapy for common sites of musculoskeletal pain (lumbar and cervical spine, knee, or hip). Generalized linear models assessed the relationship between smoking history and pain/function. RESULTS 833 patients from an integrated healthcare system were included (mean: 57.6 years, SD=16.3; 43 % male). After controlling for several variables, current smokers had significantly higher baseline pain interference scores compared to never and former smokers (beta [B]: 0.65, 95 %CI: 0.13 to 1.18, P=.02). Smoking was not a significant predictor of symptom distribution at baseline [B: 0.17, 95 %CI -0.06 to 0.42, P=.16] or physical function scores at discharge [B: -0.03, 95 %CI: -0.08 to 0.02, P=.25]. CONCLUSION Smokers experienced a greater impact of pain at baseline. However, symptom distribution at intake and function upon discharge were similar between all smoking groups. These findings suggest smoking cessation and abstinence may be important recommendations to help curb pain interference.
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Affiliation(s)
- Margaux Lojacono
- Doctor of Science in Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI 54311, USA.
| | - Brian J McClenahan
- Doctor of Science in Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI 54311, USA; Rehabilitation Department, WellSpan, Quentin Circle, 950 Isabel Dr., Lebanon, PA 17042, USA.
| | - Jane S Borgehammar
- Doctor of Science in Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI 54311, USA.
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI 54311, USA.
| | - Ronald J Schenk
- Doctor of Physical Therapy Program, Tufts University School of Medicine, 136 Harrison AvenueBoston, MA 02111, USA.
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI 54311, USA; Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, USA.
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Kieselbach K, Fauler I, Abberger B. Patients With Chronic Pain: The Aspect Of Negative Body Image. Psychother Psychosom Med Psychol 2024; 74:369-375. [PMID: 38885658 DOI: 10.1055/a-2322-8484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Negative body image is an increasingly important factor in chronic pain disorders; particularly because the two conditions mutually influence each other. Our study examines body-image-related attitudes and comorbid psychic symptoms in patients with chronic pain disorders. METHODS AND MEASURES 188 patients with chronic pain answered the Dresden body image questionnaire (DKB-35), the Hospital Anxiety and Depression Scale (HADS) and the Beck's Depression Inventory (BDI). RESULTS The mean values of the DKB-35 subscales range between 2.24 und 3.29. The subscale "vitality" has the lowest mean value. BDI and HADS correlated significantly with the DKB-35 subscales. The subscale "body-acceptance" intercorrelated high with the two subscales "vitality" and "self-aggrandizement". CONCLUSION Our findings verify that chronic pain is strongly associated with negative body image. The issues of vitality and psychological symptoms seem particularly central in this complex interaction. The biopsycho-social model and the avoidance-endurance approach to chronic pain offer important ideas for explanation and treatment.
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Affiliation(s)
| | - Ingrid Fauler
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Freiburg
| | - Birgit Abberger
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Freiburg
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Hampel P, Neumann A. [Is the relationship between depressive symptoms and work-related factors mediated by pain self-efficacy in non-specific chronic low back pain?]. Schmerz 2024; 38:335-342. [PMID: 36894792 PMCID: PMC11420306 DOI: 10.1007/s00482-023-00701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND The transition from acute to non-specific chronic low back pain (CLBP) is especially associated with psychological factors. However, working mechanisms of psychological factors have been little examined in non-specific CLBP, especially the mediator effect of pain self-efficacy. OBJECTIVE Does pain self-efficacy mediate the long-term prediction of work-related factors by depressive symptoms? METHODS Within the framework of an exploratory secondary analysis, simple mediation analyses were conducted to longitudinally predict prognosis of gainful employment, as well as subjective physical and mental work ability by depressive symptoms mediated by pain self-efficacy in 382 inpatients with non-specific CLBP. RESULTS The findings suggest that depressive symptoms prior to rehabilitation predicted levels of all three work-related factors 24 months after rehabilitation, and pain self-efficacy 12 months after rehabilitation mediated this relationship. CONCLUSION To improve the success of work-related rehabilitation in the long-term, pain self-efficacy in particular, but also depressive symptoms should be targeted by treatments of non-specific CLBP.
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Affiliation(s)
- Petra Hampel
- Institut für Gesundheits‑, Ernährungs- und Sportwissenschaften, Europa-Universität Flensburg, Auf dem Campus 1, 24943, Flensburg, Deutschland.
| | - Anne Neumann
- Institut für Gesundheits‑, Ernährungs- und Sportwissenschaften, Europa-Universität Flensburg, Auf dem Campus 1, 24943, Flensburg, Deutschland
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Abberger B, Kieselbach K. Rasch analysis of the Depression, Anxiety, and Stress Scale in patients with chronic pain. J Psychosom Res 2024; 178:111597. [PMID: 38277894 DOI: 10.1016/j.jpsychores.2024.111597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Questionnaires are commonly used to assess and screen pain-related, psychological symptoms in patients with chronic pain. In Germany, the "German pain questionnaire" provided by the German Pain Society used for this purpose includes the Depression, Anxiety, and Stress Scale (DASS). This study aims to analyze the DASS by fitting its data to the Rasch model to test the psychometric quality. STUDY DESIGN AND SETTING In this cross-sectional study, 932 patients with chronic pain answered the DASS. The 21-item short version was tested via Rasch analysis using the parameters threshold order, fit to the model, Differential Item Functioning, unidimensionality and reliability. RESULTS The Rasch analysis results showed a low reliability, misfitting items, Differential Item Functioning or multidimensionality. It was necessary to remove items from the subscales to improve fit to the Rasch model. A revised depression subscale of the DASS-21 was the only scale that achieved all the required psychometric parameters. The summation of all items to a total scale was not supported. CONCLUSION More research is required on somatic free measurement of psychological symptoms in patients with chronic pain. The results demonstrate that the development of a new instrument or a revision of existing instruments for screening of psychological symptoms in chronic pain are needed.
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Affiliation(s)
- Birgit Abberger
- Interdisciplinary Pain Center, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
| | - Kristin Kieselbach
- Interdisciplinary Pain Center, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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Köpnick A, Hampel P. [Influence of Social Status on the Success of Rehabilitation among Patients with Chronic Low Back Pain - Results of a 2-year Follow-up after Inpatient Multidisciplinary Rehabilitation]. REHABILITATION 2020; 59:348-356. [PMID: 32869248 DOI: 10.1055/a-1219-2661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Social inequality in medical rehabilitation is receiving increasing attention. The present study examined the impact of the social status on the long-term effectiveness of the pain competence and depression prevention training "Debora" among patients with chronic low back pain (CLBP) in an inpatient multidisciplinary rehabilitation. METHODS The control group study with cluster-block randomization investigated the long-term changes in pain self-efficacy, psychological burden, functional capacity, and subjective work ability among 394 patients with non-specific CLBP depending on the condition (control group, CG: pain competence training vs. intervention group, IG: additional depression prevention training) and the social status (lower, middle vs. upper class; according to Deck [1]). The data were collected at five sample points: pre (t0), post (t1), 6-(t2), 12-(t3) and 24-month follow-up (t4). Multi- or univariate repeated-measures analyses of variance were conducted per protocol (pp). In a second step, results should be confirmed by multiple imputations (MI; N=1089). RESULTS In general, patients of the lower class showed significantly worse values in depressive symptoms, functional capacity, and subjective work ability compared to the upper class. In addition, positive long-term effects could not be found among patients of the lower class. In contrast, patients of the middle and upper class improved, especially in the IG. Furthermore, only the IG showed long-term improvements in subjective work capacity. CONCLUSION This study confirms the influence of the social status on the psychophysical health. Moreover, social inequality in long-term success of rehabilitation of CLBP was suggested, which could be mediated by health literacy. Therefore, these aspects should be taken into account already in the conception and especially in the application of psychological group trainings in inpatient rehabilitation.
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Affiliation(s)
- Anne Köpnick
- Institut für Gesundheits-, Ernährungs- und Sportwissenschaften, Abteilung Gesundheitspsychologie und -bildung, Europa-Universität Flensburg
| | - Petra Hampel
- Institut für Gesundheits-, Ernährungs- und Sportwissenschaften, Abteilung Gesundheitspsychologie und -bildung, Europa-Universität Flensburg
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Konietzny K, Chehadi O, Levenig C, Kellmann M, Kleinert J, Mierswa T, Hasenbring MI. Depression and suicidal ideation in high-performance athletes suffering from low back pain: The role of stress and pain-related thought suppression. Eur J Pain 2019; 23:1196-1208. [PMID: 30821880 DOI: 10.1002/ejp.1387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depression and suicidal ideation are important health problems in athletes suffering from pain. Dysfunctional pain cognitions, that is, pain-related thought suppression (PTS), may play an important role in their aetiology. Thought suppression was shown to increase depressive mood, particularly in highly stressed individuals. This cross-sectional study examines the relationship between PTS and stress on depression and suicidal ideation in athletes with pain. METHODS A total of 159 athletes with non-specific low back pain completed a set of questionnaires to measure PTS, depression and stress. Participants were split into groups with high and low stress, and high and low PTS. Two-way ANOVA calculated main effects for PTS, stress and a PTS*stress interaction, with depressive symptoms as dependent. Subsequently, distribution tests were calculated, investigating if the presence of clinically relevant depression and suicidal ideation is dependent of conditions of high/low PTS and stress. RESULTS A main effect of stress demonstrated higher depression scores in highly stressed athletes. Further, a significant PTS*stress interaction showed elevated depression scores in athletes with high PTS and high stress. Distribution analysis revealed positive associations between PTS, stress and depression, with depression being most frequent among athletes with high PTS and high stress. Suicidal ideation was not significantly associated with PTS and only weakly correlated with stress. CONCLUSIONS Our findings show that PTS is the most common pain response in athletes with pain. The results indicate a higher prevalence of depression and elevated depressive symptoms in athletes experiencing high stress, seemingly more pronounced when highly engaging in PTS. SIGNIFICANCE This study contributes to the understanding of depression in athletes with pain, suggesting stress and pain-related thought suppression to increase symptoms and prevalence of depression. As athletes often experience acute or chronic pain, understanding the impact of pain cognitions on health outcomes is an important step in the optimization of treatments.
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Affiliation(s)
- Kerstin Konietzny
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Omar Chehadi
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Claudia Levenig
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Michael Kellmann
- Unit of Sport Psychology, Faculty of Sport Science, Ruhr University Bochum, Bochum, Germany.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jens Kleinert
- Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Tobias Mierswa
- Unit of Sport Psychology, Faculty of Sport Science, Ruhr University Bochum, Bochum, Germany
| | - Monika Ilona Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
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[Interdisciplinary pain psychology II : Risk factors, diagnostic workup, therapy and transfer in clinical practice]. Schmerz 2018; 32:233-235. [PMID: 30006837 DOI: 10.1007/s00482-018-0312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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