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Gebauer SC, Salas J, Tucker JL, Callahan LF, Scherrer JF. Depression and Time to Knee Arthroplasty Among Adults Who Have Knee Osteoarthritis. J Arthroplasty 2024:S0883-5403(24)00456-X. [PMID: 38735545 DOI: 10.1016/j.arth.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Depression is common in osteoarthritis (OA) and is associated with poor outcomes following total knee arthroplasty (TKA). Depression can increase pain sensitivity and may be related to an increased likelihood of TKA. METHODS Nationally distributed electronic health record data from 2010 to 2018 were used to identify eligible patients (n = 9,466) who had knee OA and were 45 to 80 years of age. Cox proportional hazard models were computed to estimate the association between depression and incident TKA for all patients and by age group (45 to 54, 55 to 64, and 65 to 80 years of age). Confounding was controlled using entropy balancing. Sensitivity analyses determined if the association between depression and TKA differed when depression occurred in the 12 months occurring 90, 60, 30, and 0 days lag time before TKA. RESULTS The mean age of the sample was 63 (range, 45 to 80), 64.0% were women, 83.3% were White race, and approximately 50% resided in the Midwest. There was no association between depression and incident TKA (hazard ratio = 0.97; confidence interval = 0.81 to 1.16]). Results did not differ in age-stratified analyses. Sensitivity analyses revealed a higher percentage of TKA among depressed versus nondepressed patients (24.2 versus 21.6%; P = .028) when the patient's depression diagnosis was established in the 12 months with no lag time before TKA. CONCLUSIONS Patients who have knee OA and comorbid depression, compared to those who have only knee OA, do not have an increased likelihood of TKA. The multifactorial, complex decision to obtain TKA does not appear to be influenced by depression, but depression is a common comorbidity.
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Affiliation(s)
- Sarah C Gebauer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jane L Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Leigh F Callahan
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri
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2
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Roger AH, Gudleski GD, Quigley BM, Zvolensky MJ, Lackner JM. Pain Catastrophizing and Clinical Outcomes Among Patients Receiving a Novel Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: An Experimental Therapeutics Approach. Behav Ther 2023; 54:623-636. [PMID: 37330253 DOI: 10.1016/j.beth.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) condition treated by GI and primary care physicians. Although IBS symptoms (abdominal pain, bowel problems) are generally refractory to medical therapies, consistent research has shown that they improve following cognitive-behavioral therapy (CBT). Notwithstanding empirical support for CBT, there is less research explicating the reasons for why or how it works. Like other pain disorders, the focus on change mechanisms for behavioral pain treatments has focused on pain-specific cognitive-affective processes that modulate pain experience, few of which are more important than pain catastrophizing (PC). The fact that PC changes are seen across treatments of differing theoretical and technical orientation, including CBT, yoga, and physical therapy, suggests that it may be a nonspecific (vs. theory-based) change mechanism akin to therapeutic alliance and treatment expectancy. Therefore, the current study examined change in PC as a concurrent mediator of IBS symptoms severity, global GI symptom improvement, and quality of life among 436 Rome III-diagnosed IBS patients enrolled in a clinical trial undergoing two dosages of CBT versus a nonspecific comparator emphasizing education and support. Results from structural equation modeling parallel process mediation analyses suggest that reduction in PC during treatment are significantly associated with improvement in IBS clinical outcomes through 3-month follow-up. Results from the current study provide evidence that PC may be an important, albeit nonspecific change mechanism, during CBT for IBS. Overall, reducing the emotional unpleasantness of pain through cognitive processes is associated with improved outcomes for IBS.
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3
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Morriss NJ, Kim BI, Poehlein E, Park CN, Lentz TA, Green CL, Lau BC. Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury. Orthop J Sports Med 2023; 11:23259671231163854. [PMID: 37113137 PMCID: PMC10126611 DOI: 10.1177/23259671231163854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Psychological distress after orthopaedic surgery can lead to worse outcomes, including higher levels of disability and pain and lower quality of life. The 10-item Optimal Screening for Prediction for Referral and Outcome-Yellow Flag (OSPRO-YF) survey screens for multiple psychological constructs relevant to recovery from orthopaedic injury and may be useful to preoperatively identify patients who may require further psychological assessment and possible intervention after surgery. Purpose/Hypothesis To determine the association between the OSPRO-YF and physiological patient-reported outcomes (PROs). It was hypothesized that higher OSPRO-YF scores (indicating worse psychological distress) would be associated with worse PRO scores at time of return to sport. Study Design Case series; Level of evidence, 4. Methods This study evaluated 107 patients at a single, academic health center who were assessed at a sports orthopaedics clinic and ultimately treated surgically for injuries to the knee, shoulder, foot, or ankle. Preoperatively, patients completed the OSPRO-YF survey as well as the following PRO measures: Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, numeric rating scale for pain; American Shoulder and Elbow Surgeons standardized shoulder assessment form for patients with shoulder injuries, the International Knee Documentation Committee score (for patients with knee injuries), and the Foot and Ankle Ability Measure (FAAM; for patients with foot or ankle injuries). At the time of anticipated full recovery and/or return to sport, patients again completed the same PRO surveys. Multivariable regression was used to evaluate the association between total OSPRO-YF score at baseline and PRO scores at the time of functional recovery. Results The baseline OSPRO-YF score predicted postoperative PROMIS Physical Function and FAAM Sports scores only. A 1-unit increase in the OSPRO-YF was associated with a 0.55-point reduction in PROMIS Physical Function (95% CI, -1.05 to -0.04; P = .033) indicating worse outcomes. Among patients who underwent ankle surgery, a 1-unit increase in OSPRO-YF was associated with a 6.45-point reduction in FAAM Sports (95% CI, -12.0 to -0.87; P = .023). Conclusion The study findings demonstrated that the OSPRO-YF survey predicts certain long-term PRO scores at the time of expected return to sport, independent of baseline scores.
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Affiliation(s)
- Nicholas J. Morriss
- Duke University School of Medicine,
Durham, North Carolina, USA
- Nicholas J. Morriss, BA,
Duke University School of Medicine, Duke University Medical Center, 200 Trent
Drive, Durham, NC 27710, USA (
)
| | - Billy I. Kim
- Duke University School of Medicine,
Durham, North Carolina, USA
| | - Emily Poehlein
- Department of Biostatistics and
Bioinformatics, Duke University School of Medicine Durham, North Carolina,
USA
| | - Caroline N. Park
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
| | - Trevor A. Lentz
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke
University, Durham, North Carolina, USA
| | - Cynthia L. Green
- Department of Biostatistics and
Bioinformatics, Duke University School of Medicine Durham, North Carolina,
USA
- Duke Clinical Research Institute, Duke
University, Durham, North Carolina, USA
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
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4
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Jones AM, Koehoorn M, Bültmann U, McLeod CB. Pre-existing anxiety and depression disorders and return to work after musculoskeletal strain or sprain: a phased-based approach. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:83-92. [PMID: 35666362 DOI: 10.1007/s10926-022-10047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To examine the impact of pre-existing anxiety and depression disorders on return to work (RTW) using a phase-based approach. METHODS Accepted lost-time workers' compensation claims for upper limb or spine strain or sprain from 2009 to 2013 were extracted for workers in the Canadian province of British Columbia (n = 78,186). Pre-existing anxiety and depression disorders were identified using health claims data. Probability of RTW following a first or second work lost-time episode was analyzed using Prentice, Williams and Peterson models for recurrent events (common hazards ratios (cHR)). Probability of a first lost-time recurrence was analyzed using Cox models (HR). All models included two years of follow up and were stratified by gender. RESULTS For men, anxiety alone (cHR = 0.90, 95% CI: 0.85 to 0.94) or comorbid with depression (cHR = 0.95, 95% CI: 0.92 to 0.99) was significantly associated with a lower probability of RTW, and comorbid anxiety and depression with a higher probability of recurrence (HR = 1.29, 95% CI: 1.13 to 1.48). In women, comorbid anxiety and depression was significantly associated with a lower probability of RTW (cHR = 0.96, 95% CI: 0.93 to 0.99) and a higher probability of recurrence (HR = 1.15, 95% CI: 1.04 to 1.28); and anxiety alone with a higher probability of recurrence (HR = 1.25, 95% CI: 1.09 to 1.43). There was little evidence that depression alone was associated with RTW or recurrence. CONCLUSIONS Workers with a pre-existing anxiety disorder may require additional supports both during lost-time and after initial RTW.
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Affiliation(s)
- Andrea Marie Jones
- Partnership for Work Health and Safety, School of Population and Public Health, University of British Columbia, 2206 V6T 1Z3, East Mall, Vancouver, British Columbia, Canada.
| | - Mieke Koehoorn
- Partnership for Work Health and Safety, School of Population and Public Health, University of British Columbia, 2206 V6T 1Z3, East Mall, Vancouver, British Columbia, Canada
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christopher B McLeod
- Partnership for Work Health and Safety, School of Population and Public Health, University of British Columbia, 2206 V6T 1Z3, East Mall, Vancouver, British Columbia, Canada
- Institute for Work and Health, Toronto, Ontario, Canada
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Flynn DM, McQuinn H, Burke L, Steffen A, Fairchok A, Snow T, Doorenbos AZ. Use of Complementary and Integrative Health Therapies Prior to Intensive Functional Restoration in Active Duty Service Members with Chronic Pain. PAIN MEDICINE 2021; 23:844-856. [PMID: 34791423 DOI: 10.1093/pm/pnab326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Psychosocial factors are known to predict chronic pain, and the use of complementary and integrative health (CIH) therapies to address pain is emerging among military population. However, conflicting results on pain outcomes warrant additional research. This study aimed to (1) evaluate the benefit of adding a CIH pain management program to standard rehabilitative care (SRC), as compared to SRC alone, as precursor to an intensive functional restoration (FR) program; (2) identify factors that predict improvement in pain outcomes following treatment; and (3) determine the proportion of participants who experience clinically meaningful response. DESIGN Pragmatic randomized controlled clinical trial. Participants were randomized to a 3-week course of either SRC alone or SRC+CIH (stage 1), followed by a 3- to 6-week course of FR (stage 2). SETTING AND SUBJECTS Active duty service members with chronic pain. METHODS Participants completed either SRC alone or SRC+CIH (stage 1), followed by a course of FR (stage 2). Patient-reported and provider-determined outcomes were collected at baseline, after stage 1, and after stage 2. A covariance pattern model with unstructured residual covariance matrix was used to compare treatment arms while accounting for dependency due to repeated measurements. RESULTS A total of 210 service members participated. Most were Army (82%) and male (84%). Participants randomized to the SRC+CIH intervention had greater improvement in the pain impact score than those in the SRC alone group. Predictors of outcomes were baseline impact score, anger, depression, and educational status. CONCLUSIONS This study found that military service members with the highest pain impact benefit the most from interdisciplinary pain care.
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Affiliation(s)
| | | | - Larisa Burke
- College of Nursing, University of Illinois, Chicago, USA
| | - Alana Steffen
- College of Nursing, University of Illinois, Chicago, USA
| | | | - Tyler Snow
- Madigan Army Medical Center, Washington, USA
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
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Coutinho ADDF, Oliveira-Souza AISD, Sales LR, Araújo de Oliveira D. Immediate effect of a motor control exercise target to the neck muscles on upper cervical range of motion and motor control in patients with temporomandibular disorder. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
ObjectiveTo evaluate whether a single specific motor control training session for the neck flexor and deep extensor muscles improves upper cervical range of motion and neck motor control in patients with temporomandibular disorder (TMD) and compare them to a group without TMD. MethodsThis is a before and after, controlled study. The TMD group included women aged between 18-45 years old, complaining of pain in the orofacial region in the last 6 months and diagnosed with masticatory myofascial pain according to Research Diagnostic Criteria (RDC/MD). The control group included match-controls without TMD. The participants were evaluated to global and upper (Flexion Rotation Test - FRT) neck range of motion (ROM) and to neck motor control (Cranio-Cervical Flexion Test - CCFT). They were treated with a protocol of specific motor control exercises targeted to flexor and extensor neck muscles for 30 minutes. One day after the protocol the patients were reevaluated. ResultsA total of 23 volunteers were evaluated. The TMD group showed immediate improvement in left cervical rotation (p=0.043) and right FRT (p=0.036), while the control group did not show any improvement. There was no difference between the groups before and after treatment in relation to cervical movements. Regarding cervical motor control in both groups, the highest prevalence was of results between 24 and 26 mmHg after treatment, different from before the intervention (20 and 22 mmHg) in both groups.ConclusionA single session of specific neck motor control training only improved the left cervical rotation and upper right rotation in the TMD group, but not in the control group. There is no difference at the end of treatment between the groups. Volunteers with TMD showed improvement in the pattern of motor control of the neck when compared to volunteers without TMD.
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7
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Chronic Plantar Heel Pain Is Principally Associated With Waist Girth (Systemic) and Pain (Central) Factors, Not Foot Factors: A Case-Control Study. J Orthop Sports Phys Ther 2021; 51:449-458. [PMID: 33962520 DOI: 10.2519/jospt.2021.10018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain. DESIGN Case-control. METHODS We investigated associations by comparing 220 participants with chronic (more than 3 months in duration) plantar heel pain to 100 age- and sex-matched controls, who were recruited randomly from the electoral roll. Exposures measured were waist girth, body mass index, body composition, clinical measures of foot and leg function, physical activity via accelerometry, depression and pain catastrophizing, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analyzed using multivariable conditional logistic regression. RESULTS Waist girth (centimeters) (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.03, 1.09), ankle plantar flexor strength (kilograms) (OR = 0.98; 95% CI: 0.97, 0.99), pain at multiple sites (pain at 1 other site: OR = 2.76; 95% CI: 1.29, 5.91; pain at 4 or more other sites: OR = 10.45; 95% CI: 3.66, 29.81), and pain catastrophizing status (none, some, or catastrophizer) (some: OR = 2.91; 95% CI: 1.33, 6.37; catastrophizer: OR = 6.79; 95% CI: 1.91, 24.11) were independently associated with chronic plantar heel pain. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension range of motion, depression, and body mass index. There were no significant associations with physical activity or body composition (bioelectrical impedance analysis). CONCLUSION Waist girth, ankle plantar flexor strength, multisite pain, and pain catastrophizing, but not foot-specific factors, were independently associated with chronic plantar heel pain. Of these 4 factors, 3 (waist girth, multisite pain, and pain catastrophizing) were central or systemic associations. J Orthop Sports Phys Ther 2021;51(9):449-458. Epub 7 May 2021. doi:10.2519/jospt.2021.10018.
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8
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Jones AM, Koehoorn M, Bültmann U, McLeod CB. Impact of anxiety and depression disorders on sustained return to work after work-related musculoskeletal strain or sprain: a gender stratified cohort study. Scand J Work Environ Health 2021; 47:296-305. [PMID: 33744976 PMCID: PMC8091074 DOI: 10.5271/sjweh.3951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: The aim of this study was to examine the impact of anxiety and depression disorders on sustained return to work (RTW) for men and women with musculoskeletal strain or sprain. Methods: Accepted lost-time claims for spine and upper-extremity strain or sprain were extracted for workers in the Canadian province of British Columbia from 2009 to 2013 (N=84 925). Pre-existing and new onset anxiety and depression disorders were identified using longitudinal health claims data. Probability of sustained RTW was analyzed using Cox proportional hazards models, stratified by gender and adjusted for potential confounders. Results: For pre-existing disorders, compared to men with no anxiety and no depression, men with anxiety only [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.84–0.93], depression only (HR 0.94, 95% CI 0.89–1.00), and anxiety and depression (HR 0.93, 95% CI 0.90–0.97) had lower probabilities of sustained RTW in adjusted models. The same direction of effect was found for women, but anxiety only had a smaller effect size among women compared to men (HR anxiety only 0.95, 95% CI 0.92–0.99; HR depression only 0.98, 95% CI 0.93–1.03, HR anxiety and depression 0.94, 95% CI 0.91–0.97). Among men and women, new onset disorders were associated with lower probability of sustained RTW and the effect estimates were larger than for pre-existing disorders. Conclusions: Findings suggest that workers’ compensation benefits and programs intended to improve RTW after musculoskeletal injury should take pre-existing and new onset anxiety and depression disorders into consideration and that gender-sensitive work disability strategies may be warranted.
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Affiliation(s)
- Andrea Marie Jones
- School of Population and Public Health, 2206 East Mall, University of British Columbia, Vancouver, British Columbia, Canada, V6T 1Z3.
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9
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Terradas-Monllor M, Navarro-Fernández G, Ruiz MA, Beltran-Alacreu H, Fernández-Carnero J, Salinas-Chesa J, Ochandorena-Acha M. Postoperative Psychosocial Factors in Health Functioning and Health-Related Quality of Life After Knee Arthroplasty: A 6-Month Follow up Prospective Observational Study. PAIN MEDICINE 2021; 22:1905-1915. [PMID: 33538821 DOI: 10.1093/pm/pnab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Knee arthroplasty (KA) is an effective and cost-effective treatment for end-stage knee osteoarthritis. Despite high surgical success rates, as many as 25% of patients report compromised postoperative functioning, persistent pain, and reduced quality of life. The purpose of this study was to assess the predictive value of psychological factors in health functioning and quality of life, during a 6-month period after KA. DESIGN A prospective observational study. SETTING Surgery at two hospitals and follow-up was carried out through the domiciliary rehabilitation service. SUBJECTS In total, 89 patients (age 70.27 ± 7.99 years) met the inclusion criteria. METHOD A test battery composed of Health functioning associated with osteoarthritis (WOMAC), Health-related quality of life (EQ-5D-5L), Anxiety and Depression (HADS), Pain attitudes (SOPA-B), Pain catastrophizing (PCS), and Fear of Movement (TSK-11) was assessed at 1 week, and 1, 3, and 6 months after surgery. A mixed effects linear model was used to estimate the effect of time and covariates. An exploratory factor analysis was used to identify the number of dimensions underlying the group of psychological measurements. RESULTS In WOMAC model, anxiety level (F = 120.8), PCS (F = 103.9), depression level (F = 93.6) and pain score (F = 72.8) were the most influential variables. Regarding EQ-5D-5L model, anxiety level (F = 98.5), PCS (F = 79.8), depression level (F = 78.3) and pain score (F = 45) were the most influential variables. Pain score and the psychosocial variables of PCS, TSK, HADS-A, HADS-D, SOPA-B Emotion, SOPA-B Harm and SOPA-B Disability loaded in one single dimension. CONCLUSIONS Postoperative acute pain and psychosocial factors of pain catastrophizing, anxiety, depression, and pain attitudes might influence health functioning and quality of life during KA rehabilitation. Such factors could be gathered into one single dimension defined as pain-related psychologic distress.
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Affiliation(s)
- Marc Terradas-Monllor
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia, Vic, Spain.,Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Institut de Rehabilitació i Terapèutica Biofísica (IRITEB), Badalona, Spain.,Programa de Doctorat en Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Gonzalo Navarro-Fernández
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid Madrid, Spain
| | - Miguel A Ruiz
- Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Hector Beltran-Alacreu
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.,Unit of Physiotherapy, Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.,Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, Madrid, Spain
| | | | - Mirari Ochandorena-Acha
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia, Vic, Spain.,Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
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10
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Zubatsky M, Witthaus M, Scherrer JF, Salas J, Gebauer S, Burge S, Schneider FD. The association between depression and type of treatments received for chronic low back pain. Fam Pract 2020; 37:348-354. [PMID: 31746992 PMCID: PMC7755115 DOI: 10.1093/fampra/cmz062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression is associated with receipt of opioids in non-cancer pain. OBJECTIVES To determine whether the receipt of opioid therapy modifies the relationship of depression and use of multiple non-opioid pain treatments. METHODS Patients (n = 320) with chronic low back pain (CLBP) were recruited from family medicine clinics and completed questionnaires that measured use of home remedies, physical treatments requiring a provider and non-opioid medication treatments. A binary variable defined use (yes/no) of all three non-opioid treatment categories. Depression (yes/no) was measured with the PHQ-2. The use of opioids (yes/no) was determined by medical record abstraction. Unadjusted and adjusted logistic regression models, stratified on opioid use, estimated the association between depression and use of all three non-opioid treatments. RESULTS Participants were mostly female (71.3%), non-white (57.5%) and 69.4% were aged 18 to 59 years. In adjusted analyses stratified by opioid use, depression was not significantly associated with using three non-opioid treatments (OR = 2.20; 95% CI = 0.80-6.07) among non-opioid users; but among opioid users, depression was significantly associated with using three non-opioid treatments (OR = 3.21; 95% CI: 1.14-8.99). These odds ratios were not significantly different between opioid users and non-users (P = 0.609). CONCLUSION There is modest evidence to conclude that patients with CLBP and comorbid depression, compared with those without depression, were more likely to try both opioid and non-opioid pain treatments. Non-response to other pain treatments may partly explain why depression is associated with greater prescription opioid use.
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Affiliation(s)
- Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Matthew Witthaus
- Family Medicine Center at University Village, University of Illinois Hospital, Chicago, IL, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Sarah Gebauer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Sandra Burge
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - F David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Slepian PM, Ankawi B, France CR. Longitudinal Analysis Supports a Fear-Avoidance Model That Incorporates Pain Resilience Alongside Pain Catastrophizing. Ann Behav Med 2019; 54:335-345. [DOI: 10.1093/abm/kaz051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
The fear-avoidance model of chronic pain holds that individuals who catastrophize in response to injury are at risk for pain-related fear and avoidance behavior, and ultimately prolonged pain and disability.
Purpose
Based on the hypothesis that the predictive power of the fear-avoidance model would be enhanced by consideration of positive psychological constructs, the present study examined inclusion of pain resilience and self-efficacy in the model.
Methods
Men and women (N = 343) who experienced a recent episode of back pain were recruited in a longitudinal online survey study. Over a 3-month interval, participants repeated the Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, the McGill Pain Questionnaire, and NIH-recommended measures of pain, depressive symptoms, and physical dysfunction. Structural equation modeling assessed the combined contribution of pain resilience and pain catastrophizing to 3-month outcomes through the simultaneous combination of kinesiophobia and self-efficacy.
Results
An expanded fear-avoidance model that incorporated pain resilience and self-efficacy provided a good fit to the data, Χ2 (df = 14, N = 343) = 42.09, p = .0001, RMSEA = 0.076 (90% CI: 0.05, 0.10), CFI = 0.97, SRMR = 0.03, with higher levels of pain resilience associated with improved 3-month outcomes on measures of pain intensity, physical dysfunction, and depression symptoms.
Conclusions
This study supports the notion that the predictive power of the fear-avoidance model of pain is enhanced when individual differences in both pain-related vulnerability (e.g., catastrophizing) and pain-related protective resources (e.g., resilience) are considered.
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Affiliation(s)
| | - Brett Ankawi
- Department of Psychology, Ohio University, Athens, OH, USA
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12
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The Relationship Between Level of Catastrophizing and Mental Health Comorbidity in Individuals With Whiplash Injuries. Clin J Pain 2019; 35:880-886. [PMID: 31433319 DOI: 10.1097/ajp.0000000000000749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pain catastrophizing has been shown to be correlated with measures of mental health problems such as depression and post-traumatic stress disorder (PTSD). However, the clinical implications of findings reported to date remain unclear. To date, no study has been conducted to determine meaningful cut-scores on measures of catastrophizing indicative of the heightened risk of mental health comorbidity. One objective of the present study was to identify the cut-score on the Pain Catastrophizing Scale (PCS) indicative of the heightened risk of the comorbidity of depression and PTSD. A second objective was to determine whether mental health comorbidity mediated the relationship between catastrophizing and occupational disability. MATERIALS AND METHODS The sample consisted of 143 individuals with whiplash injuries. Pain severity, pain catastrophizing, depression, and post-traumatic stress symptoms were assessed after admission to a rehabilitation program. Mental health comorbidity was operationally defined as obtaining a score above the clinical threshold on measures of depressive and/or post-traumatic stress symptom severity. RESULTS A receiver operating characteristic curve analysis revealed that a PCS score of 22 best distinguished between participants with and without mental health comorbidity. Results also revealed that mental health comorbidity mediated the relationship between catastrophizing and occupational disability. DISCUSSION The findings suggest that a score of ≥22 on the PCS should alert clinicians to the possibility that patients might also be experiencing clinically significant symptoms of depression or PTSD. Greater attention to the detection and treatment of mental health conditions associated with whiplash injury might contribute to more positive recovery outcomes.
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13
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Driver C, Lovell GP, Oprescu F. Physiotherapists' views, perceived knowledge, and reported use of psychosocial strategies in practice. Physiother Theory Pract 2019; 37:135-148. [PMID: 30870078 DOI: 10.1080/09593985.2019.1587798] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Research has addressed the usefulness of psychosocial strategies within physiotherapy, as part of a biopsychosocial model. A lack of current research in Australia concerning the views of physiotherapists, from a range of practice areas, regarding a variety of strategies, suggests the need for broader exploration. Methods: This research employed a cross-sectional survey asking Australian physiotherapists (n = 251) to rate their perceived importance and perceived benefits of psychosocial strategies; perceived positive effects on rehabilitation outcomes and adherence; confidence in applying strategies, and perceived benefits of further training. Data were analyzed using descriptive statistics, Crosstabs with Chi-Squared Tests of Contingencies and Spearman's Rank-Order Correlations. Results: Physiotherapists reported that having knowledge of such strategies was important and considered them beneficial for practice. Respondents rated highly their perceived knowledge about goal setting and positive reinforcement, both of which were reported as most used in practice. Approximately one quarter of physiotherapists reported using cognitive behavioral therapy and motivational interviewing. Physiotherapists communicated a lack of confidence to apply psychosocial strategies in their practice, and desired further training. Conclusion: Physiotherapists could benefit from tailored instruction regarding psychosocial strategies at a level appropriate to, and within their scope of practice. This could enhance their practice from a biopsychosocial perspective, subsequently improving outcomes for their patients.
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Affiliation(s)
- Christina Driver
- School of Social Sciences, University of the Sunshine Coast , Maroochydore, Queensland, Australia
| | - Geoff P Lovell
- School of Social Sciences, University of the Sunshine Coast , Maroochydore, Queensland, Australia
| | - Florin Oprescu
- School of Health and Sport Science, University of the Sunshine Coast , Maroochydore, Queensland, Australia
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14
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Shaw WS, Hartvigsen J, Woiszwillo MJ, Linton SJ, Reme SE. Psychological Distress in Acute Low Back Pain: A Review of Measurement Scales and Levels of Distress Reported in the First 2 Months After Pain Onset. Arch Phys Med Rehabil 2016; 97:1573-1587. [DOI: 10.1016/j.apmr.2016.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 01/11/2016] [Accepted: 02/04/2016] [Indexed: 11/15/2022]
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15
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Høvik LH, Winther SB, Foss OA, Gjeilo KH. Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up. BMC Musculoskelet Disord 2016; 17:214. [PMID: 27188877 PMCID: PMC4869354 DOI: 10.1186/s12891-016-1073-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
Background Pain relief is likely to be the most important long-term outcome for patients undergoing total knee arthroplasty (TKA). However, research indicates that persistent pain (> 3 months) is a considerable problem, affecting up to 34 % of patients. Pain catastrophizing might contribute to acute and persistent pain experienced after surgery. The primary aim of the present study was to examine the association between preoperative pain catastrophizing and postoperative pain in patients undergoing TKA up to one year after surgery. Second, we wanted to investigate a possible shift in postoperative catastrophizing. Methods In this prospective cohort study, 71 TKA patients were included consecutively between January and June 2013. Pain was assessed with the Brief Pain Inventory (BPI) and the item “average pain” was used as the main outcome. Pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). Questionnaires were completed prior to surgery (baseline) and at two days, two weeks, eight weeks and one year postoperatively. Results Mean (SD) preoperative pain score was 5.4 (2.2), reduced to 2.9 (2.3) after eight weeks and 2.4 (2.4) after one year (p < 0.001). The overall median preoperative PCS score was 17.0 (7.8–28.3). The overall model estimated PCS mean score was 7.6 at eight weeks and 6.5 at one year follow-up. The results at eight weeks and one year follow-up were both significantly lower than the preoperative value (p < 0.001). The preoperative PCS score was not associated with the postoperative pain score (p = 0.942), while preoperative pain was a significant covariate in the mixed linear model (p < 0.001). Conclusions No associations were found between preoperative pain catastrophizing and pain eight weeks or one year after surgery. The decrease in PCS-scores challenges evidence regarding the stability of pain catastrophizing. However, larger studies of psychological risk factors for pain after TKA are warranted.
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Affiliation(s)
- Lise Husby Høvik
- Clinic of Anaesthesia and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Postboks 3250, N-7006, Trondheim, Norway.
| | - Siri Bjørgen Winther
- Orthopaedic Research Center, Orthopaedic Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav A Foss
- Orthopaedic Research Center, Orthopaedic Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Hanne Gjeilo
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Schomacher J, Erlenwein J, Dieterich A, Petzke F, Falla D. Can neck exercises enhance the activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels? ACTA ACUST UNITED AC 2015; 20:694-702. [PMID: 25935795 DOI: 10.1016/j.math.2015.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 01/06/2023]
Abstract
The deep cervical extensor, semispinalis cervicis, displays changes in behaviour and structure in people with chronic neck pain yet there is limited knowledge on how activation of this muscle can be emphasized during training. Using intramuscular electromyography (EMG), this study investigated the activity of the deep semispinalis cervicis and the superficial splenius capitis muscle at two spinal levels (C2 and C5) in ten healthy volunteers during a series of neck exercises: 1. Traction and compression, 2. Resistance applied in either flexion or extension at the occiput, at the level of the vertebral arch of C1 and of C4, and 3. Maintaining the neck in neutral while inclined on the elbows, with and without resistance at C4. The ratio between semispinalis cervicis and the splenius capitis EMG amplitude was quantified as an indication of whether the exercise could emphasize the activation of the semispinalis cervicis muscle relative to the splenius capitis. Manual resistance applied in extension over the vertebral arch emphasized the activation of the semispinalis cervicis relative to the splenius capitis at the spinal level directly caudal to the site of resistance (ratio: 2.0 ± 1.1 measured at C5 with resistance at C4 and 2.1 ± 1.2 measured at C2 with resistance at C1). This study confirmed the possibility of emphasizing the activation of the semispinalis cervicis relative to the splenius capitis which may be relevant for targeted exercise interventions for this deep extensor muscle. Further studies are required to investigate the clinical efficacy of these exercises for people with neck pain.
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Affiliation(s)
| | - Joachim Erlenwein
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Angela Dieterich
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Frank Petzke
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Deborah Falla
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany; Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology (BFNT) Göttingen, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
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17
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Brown MN. Physical Medicine and Rehabilitation in the Opioid Addicted Patient. Subst Abus 2015. [DOI: 10.1007/978-1-4939-1951-2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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López-Martínez AE. The overlap of PTSD and chronic pain: a challenge for rehabilitation interventions. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x14y.0000000159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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19
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Flink IK, Boersma K, Linton SJ. Changes in Catastrophizing and Depressed Mood During and After Early Cognitive Behaviorally Oriented Interventions for Pain. Cogn Behav Ther 2014; 43:332-41. [DOI: 10.1080/16506073.2014.940605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Toth C, Brady S, Hatfield M. The importance of catastrophizing for successful pharmacological treatment of peripheral neuropathic pain. J Pain Res 2014; 7:327-38. [PMID: 25028563 PMCID: PMC4077695 DOI: 10.2147/jpr.s56883] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective Catastrophizing may be a negative predictor of pain-related outcomes. We evaluated the impact of catastrophizing upon success of first-line pharmacotherapy in the management of neuropathic pain (NeP) due to peripheral polyneuropathy. Methods Patients with confirmed NeP with NeP Visual Analog Scale (VAS) pain severity score ≥4 (0–10 scale) completed the Coping Strategies Questionnaire (CSQ) catastrophizing subscale at baseline. Pharmacological therapy consisting of first-line agents gabapentin, pregabalin, or a tricyclic antidepressant was initiated. Other measures examined included the Karnofsky Performance Scale, Beck Depression Inventory, EuroQol Quality of Life Health Questionnaire, and Modified Brief Pain Inventory. At 3 and 6 months, questionnaires were repeated and adverse effect reporting was completed. Outcome measures assessed were pharmacotherapy success (≥30% relief of NeP) and tolerability over 6 months of follow-up. Bivariate relationships using Pearson product-moment correlations were examined for baseline CSQ catastrophizing subscale score and the change in the NeP VAS scores and medication discontinuation. Results Sixty-six patients were screened, 62 subjects participated, and 58 subjects (94%) completed the final follow-up visit. Greater catastrophizing was associated with poor pain relief response and greater likelihood of discontinuation of pharmacotherapy, reports of greater disability, and impaired quality of life. Duration of pain was negatively associated with likelihood of pharmacotherapy success. Conclusion Catastrophizing exerts maladaptive effects on outcomes with pharmacotherapy in NeP patients. Detection of catastrophizing during clinical visits when pharmacological therapy is being considered can be a predictive factor for patient outcomes.
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Affiliation(s)
- Cory Toth
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Shauna Brady
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Melinda Hatfield
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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