Waddell's symptoms as correlates of vulnerabilities associated with fear-anxiety-avoidance models of pain: pain-related anxiety, catastrophic thinking, perceived disability, and treatment outcome

Effects of Vibration and Cold Application on Pain and Anxiety During Intravenous Catheterization

PURPOSE

To determine the effects of vibration and cold gel pack application on pain and anxiety levels of patients undergoing intravenous (IV) catheterization.

DESIGN

A randomized controlled, pretest and post-test experimental study.

METHODS

Catheterization was performed 60 seconds before the IV catheterization procedure was started by applying vibration and cold gel pack to patients in the experimental group. Patients in the control group underwent catheterization using standard procedures.

FINDINGS

The mean pain scores of patients in the experimental group were lower than those of the patients in the control group. Intragroup analysis demonstrated that the mean scores obtained from the state anxiety and trait anxiety inventories after the study were not significantly different from those obtained before the study.

CONCLUSIONS

Vibration and cold gel pack application is suggested to relive pain during IV catheterization in adults.

A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain

Background

The fear-avoidance model of chronic pain has established avoidance as a predictor of negative outcomes in chronic pain patients. Avoidance, or deliberate attempts to suppress or prevent unwanted experiences (e.g., pain), has been studied extensively, with multiple reviews implicating this behavior as a predictor of disability, physical disuse, and depression. Despite hundreds of studies examining the associations between different components of this model (i.e., catastrophizing, fear, avoidance, depression), the association between fear-avoidance and pain intensity has remained unclear. The present study seeks to clarify this association across samples.

Method

The present analyses synthesize the literature (articles from PsycInfo, PubMed, and ProQuest) to determine if fear-avoidance and pain intensity are consistently correlated across studies, samples, and measures. Eligible studies measured pain intensity and fear-avoidance cross-sectionally in chronic pain patients. The search resulted in 118 studies eligible for inclusion. A random-effects model was used to estimate the weighted mean effect size. Comprehensive Meta-Analysis software was used for all analyses. Moderation analyses elucidate the variables that affect the strength of this association. Meta-regression and meta-ANOVA analyses were conducted to examine moderating variables. Moderator variables include demographic characteristics, pain characteristics, study characteristics, and national cultural characteristics (using Hofstede’s cultural dimensions). Publication bias was examined using the funnel plot and the p-curve.

Results

Results indicate a small-to-moderate positive association between fear-avoidance and pain intensity. The results were stable across characteristics of the sample, including mean age, gender distribution, marital status, and duration of pain. Moderation analyses indicate that the measures utilized and cultural differences affect the strength of this association. Weaker effect sizes were observed for studies that utilized measures of experiential avoidance when compared to studies that utilized pain-specific fear-avoidance measures. Studies that utilized multiple measures of fear-avoidance had stronger effect sizes than studies that utilized a single measure of fear-avoidance. Three of Hofstede’s cultural dimensions moderated the association, including Power Distance Index, Individualism versus Collectivism, and Indulgence versus Restraint.

Conclusions

The present meta-analysis synthesizes the results from studies examining the association between fear-avoidance and pain intensity among individuals with chronic pain. The positive association indicates that those with increased fear-avoidance have higher pain intensity, and those with higher pain intensity have increased fear-avoidance. Findings indicate that cultural differences and measurement instruments are important to consider in understanding the variables that affect this association. The significant cultural variations may indicate that it is important to consider the function of avoidance behavior in different cultures in an effort to better understand each patient’s cultural beliefs, as well as how these beliefs are related to pain and associated coping strategies.

Implications

The results from the current meta-analysis can be used to inform interventions for patients with chronic pain. In particular, those with more intense pain or increased fear-avoidance should be targeted for prevention and intervention work. Within the intervention itself, avoidance should be undermined and established as an ineffective strategy to manage pain in an effort to prevent disability, depression, and physical deconditioning.

Fear of the unknown: One fear to rule them all?

The current review and synthesis was designed to provocatively develop and evaluate the proposition that "fear of the unknown may be a, or possibly the, fundamental fear" (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research.

Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review

QUESTION

Are submaximal and maximal exercise tests reliable, valid and acceptable in people with chronic pain, fibromyalgia and fatigue disorders?

DESIGN

Systematic review of studies of the psychometric properties of exercise tests.

PARTICIPANTS

People older than 18 years with chronic pain, fibromyalgia and chronic fatigue disorders.

INTERVENTION

Studies of the measurement properties of tests of physical capacity in people with chronic pain, fibromyalgia or chronic fatigue disorders were included.

OUTCOME MEASURES

Studies were required to report: reliability coefficients (intraclass correlation coefficient, alpha reliability coefficient, limits of agreements and Bland-Altman plots); validity coefficients (intraclass correlation coefficient, Spearman's correlation, Kendal T coefficient, Pearson's correlation); or dropout rates.

RESULTS

Fourteen studies were eligible: none had low risk of bias, 10 had unclear risk of bias and four had high risk of bias. The included studies evaluated: Åstrand test; modified Åstrand test; Lean body mass-based Åstrand test; submaximal bicycle ergometer test following another protocol other than Åstrand test; 2-km walk test; 5-minute, 6-minute and 10-minute walk tests; shuttle walk test; and modified symptom-limited Bruce treadmill test. None of the studies assessed maximal exercise tests. Where they had been tested, reliability and validity were generally high. Dropout rates were generally acceptable. The 2-km walk test was not recommended in fibromyalgia.

CONCLUSION

Moderate evidence was found for reliability, validity and acceptability of submaximal exercise tests in patients with chronic pain, fibromyalgia or chronic fatigue. There is no evidence about maximal exercise tests in patients with chronic pain, fibromyalgia and chronic fatigue.

Reduced neck-shoulder muscle strength and aerobic power together with increased pericranial tenderness are associated with tension-type headache in girls: A case-control study

BACKGROUND

Tension-type headaches (TTH) are common among children worldwide and mean a potential risk of disability and medication overuse headache. The associated mechanisms, however, remain unsolved. Our study investigated muscle strength in the neck-shoulder region, aerobic power and pericranial tenderness in girls with TTH compared with healthy controls.

METHODS

A blinded case-control study comprising 41 girls with TTH and 41 age-matched healthy controls. Standardised testing of isometric maximal voluntary contraction (MVC) and force steadiness of neck flexion and extension, as well as MVC and rate-of-force development of dominant shoulder, was conducted. VO2 max was recorded by a submaximal ergometer test and pericranial tenderness by standardised manual palpation. Logistic regression analyses were applied.

RESULTS

Girls with TTH demonstrated significantly higher pericranial tenderness than controls, in correlation with headache frequency (r = 0.66, p < 0.001). Results indicated that the odds ratio of girls having headache are 7.6 (95% CI 1.4-40.9) for weak to strong shoulder muscles; weak to average neck-shoulder strength OR 3.1 (95% CI 1.2-8.1); neck flexion strength OR 1.3 (95% CI 1.0-1.6) and 5.2 (95% CI: 1.4-19.6) for each unit of decrease in VO2 max.

CONCLUSIONS

Reduced neck-shoulder strength and aerobic power together with increased pericranial tenderness are associated with TTH in girls. Future interventions should be directed towards health promoting patient educational programmes on enhanced physical exercising. Much more exact and detailed research in young girls and boys are needed.

Fear of injury predicts self-reported and behavioral impairment in patients with chronic low back pain

Fear of injury has been posited as crucial in pain-related anxiety and in the development of chronic pain; however, research has only measured fear of injury indirectly through other constructs (eg, fear of illness and fear of movement). The current study tested fear of injury as an independent contributor to pain-related anxiety and impairment. Patients (n = 78; 37% women) in a work-hardening treatment program for chronic low back pain completed self-report measures of pain-related anxiety, anxiety sensitivity, fear of injury, current pain, and impairment. Behavioral measures of impairment included lifting capacity, treatment outcomes, and days absent from treatment. Structural equation modeling tested the role of fear of injury within contemporary theory. Fit for the theoretical model was excellent and superior to an alternative model. Variance accounted for in pain-related anxiety by fear of injury, anxiety sensitivity, and current pain was 64%, while pain-related anxiety and current pain predicted 49% of variance in latent impairment. Fear of injury directly predicted pain-related anxiety (β = .42) and indirectly predicted impairment through pain-related anxiety (β = .19). Fear of injury may warrant theoretical and clinical consideration as an important contributor to pain-related anxiety and impairment; however, research is needed to explore how it may be causally related with other constructs.

PERSPECTIVE

Fear of injury directly predicts pain-related anxiety and indirectly predicts self-reported and behavioral impairment. Fear of injury may warrant inclusion in contemporary theories of chronic pain. Clinicians may benefit from considering the construct in interventions for chronic pain.

The illness/injury sensitivity index: validation of a German version of the ISI-R

Three fundamental fears-anxiety sensitivity, fear of negative evaluation, and illness/injury sensitivity-are considered integral components of anxiety-related psychopathology and also bear connections with chronic pain. Scales measuring the first two fears, the Anxiety Sensitivity Index and the Fear of Negative Evaluation Scale, have been translated into German; however, the nine-item Illness/Injury Sensitivity Index-Revised (ISI-R) that measures fears of injury and illness has not been available in German language yet. The aim of this study therefore was a translation of the ISI-R into German language and an initial validation of the translated scale in two different samples. The German ISI-R was translated by both professionals and laypersons, and a final version was decided on by consensus. In Study 1, participants included 96 undergraduate students (85% women) who completed the German version of the ISI as part of a larger study. An exploratory factor analysis with oblique rotation was conducted and suggested a two-factor-solution with one factor representing fears of illness and the other fears of injury. This factor structure was confirmed via a confirmatory factor analysis (CFA) in Study 2. Participants included 117 community members (79% women). Convergent validity was supported using a visual analogue scale for fear of illness in both samples and the German translation of the Whiteley Index in Study. Overall, the results supported the German translation of the ISI-R. Comprehensive results, limitations, and directions for future research are discussed.