The Italian version of the Pain Beliefs and Perceptions Inventory: cross-cultural adaptation, factor analysis, reliability and validity

Effects of Executive Functions and Cognitive Variables in Experimentally Induced Acute Pain Perception during a Distraction Task: A Study on Asymptomatic Pain-Free Individuals

The aim of this study was to investigate the influence of executive functioning and cognitive performance on individual experimentally induced pain perception during distractor tasks in an asymptomatic pain-free population. A total of 59 healthy pain-free subjects (59.3% women, mean age: 46.5 ± 24.7 years) completed a battery test that assessed execution functions (cognitive flexibility, working memory, mental inhibition), attention level, and psychological aspects (anxiety/depressive levels-HADS, pain catastrophizing-PCS, pain anxiety symptoms-PASS 20, sleep quality-PSQI) before conducting two n-back distraction tasks. Pain was experimentally induced with a thermal stimulus that was able to induce moderate pain (70/100 points) and applied to the non-dominant forearm. The thermal stimulus was applied before and during both (one-back and two-back) distraction tasks. The analyses consisted of separated repeated-measures ANOVA that considered the functioning on each test (cognitive flexibility, working memory, mental inhibition, selective attention) and controlled for sociodemographic and psychological aspects by comparing the pain intensity at the baseline and during the one-back and two-back distractor tasks. All ANOVAs found a significant effect of the distraction task, which indicates that the perceived pain intensity scores were lower during the one-back and two-back tasks (p < 0.001) as compared with the baseline. No interaction effect between the distractor tasks and working memory (p = 0.546), mental inhibition (p = 0.16), cognitive flexibility (p = 0.069), or selective attention (p = 0.105) was identified. The current study found that a distraction task decreased the perceived intensity of experimentally induced pain in asymptomatic pain-free individuals and that this effect was not related to executive function or attention levels.

Classification of pain intensity with the pain beliefs and perceptions inventory (PBPI) and the pain catastrophizing scales (PCS)

PURPOSE

The pain beliefs and perceptions inventory (PBPI) and the pain catastrophizing scales (PCS) characterize beliefs or distress dimensions of the pain experience. It is relatively unknown, however, to what degree the PBPI and the PCS are well suited to classifying pain intensity.

METHODS

This study applied a receiver operating characteristic (ROC) approach to these instruments against the criterion of a visual analogue scale (VAS) of pain intensity with fibromyalgia and chronic back pain patients (n = 419).

RESULTS

The largest areas under the curve (AUC) were moderate and limited to the constancy subscale (71%) and total score (70%) of the PBPI and to the helplessness subscale (75%) and total score (72%) of the PCS. The best cut-off scores for the PBPI and PCS were better off at detecting true negatives than true positives, with larger specificity than sensitivity values.

CONCLUSION

Whereas, the PBPI and PCS are certainly useful instruments to evaluate diverse pain experiences, they may be inappropriate to classify intensity. The PCS performs marginally better than the PBPI for classifying pain intensity.

Associations between anger and chronic primary pain: a systematic review and meta-analysis

OBJECTIVES

Anger is a negative emotion characterized by antagonism toward someone or something, is rooted in an appraisal or attribution of wrongdoing, and is accompanied by an action tendency to undo the wrongdoing. Anger is prevalent in individuals with chronic pain, especially those with chronic primary pain. The associations between anger and pain-related outcomes (e.g., pain intensity, disability) have been examined in previous studies. However, to our knowledge, no systematic review or meta-analysis has summarized the findings of anger-pain associations through a focus on chronic primary pain. Hence, we sought to summarize the findings on the associations of anger-related variables with pain and disability in individuals with chronic primary pain.

METHODS

All studies reporting at least one association between anger-related variables and the two pain-related outcomes in individuals with chronic primary pain were eligible. We searched electronic databases using keywords relevant to anger and chronic primary pain. Multiple reviewers independently screened for study eligibility, data extraction, and methodological quality assessment.

RESULTS

Thirty-eight studies were included in this systematic review, of which 20 provided data for meta-analyses (2,682 participants with chronic primary pain). Of the included studies, 68.4% had a medium methodological quality. Evidence showed mixed results in the qualitative synthesis. Most anger-related variables had significant positive pooled correlations with small to moderate effect sizes for pain and disability.

CONCLUSIONS

Through a comprehensive search, we identified several key anger-related variables associated with pain-related outcomes. In particular, associations with perceived injustice were substantial.

Validity and reliability of the Greek version of the Pain Beliefs and Perceptions Inventory for patients with chronic pain

Background/aims

The Pain Beliefs and Perceptions Inventory has been used widely to evaluate pain perceptions and beliefs of patients with chronic pain. This is a cross-cultural adaptation of the instrument into Greek. The purpose of the study was to investigate: the face and content validity; the factor structure; the concurrent validity; the discriminant validity; and the internal consistency and the test–retest reliability of the Pain Beliefs and Perceptions Inventory for people with chronic pain.

Methods

A total of 174 patients with chronic low back pain, neck pain and/or pain of limbs lasting for at least 6 months and with a physiotherapy referral participated in the study. Exploratory factor analysis by a principal axis factoring with direct oblimin rotation was chosen to examine the factor structure of the Pain Beliefs and Perceptions Inventory. The concurrent validity was assessed using correlations by Spearman's rho correlation coefficient among the Pain Beliefs and Perceptions Inventory and the Short Form-McGill Pain Questionnaire, the Present Pain Index, the visual analogue scale and the Brief Pain Inventory. The discriminant validity was examined by Spearman's rho correlation coefficient among the Pain Beliefs and Perceptions Inventory and Social Desirability Scale. The reliability of the instrument was examined using Cronbach's α internal consistency coefficients and intraclass correlation coefficients.

Results

Exploratory factor analysis confirmed the four factor structure of the Pain Beliefs and Perceptions Inventory that explained 66.353% of the total variance. Concurrent validity was determined through examination of correlations between the Pain Beliefs and Perceptions Inventory and other validated constructs (eg Short Form-McGill Pain Questionnaire Affective factor with Total Pain Beliefs and Perceptions Inventory Spearman's rho=0.257, P<0.001, Brief Pain Inventory General Activity and Pain Beliefs and Perceptions Inventory Constancy factor Spearman's rho=0.522, P<0.05, Brief Pain Inventory relations with other people and Pain Beliefs and Perceptions Inventory Constancy factor Spearman's rho=0.512, P<0.05). The discriminant validity of the Pain Beliefs and Perceptions Inventory was confirmed by examining correlations between the Pain Beliefs and Perceptions Inventory with the Marlowe–Crowne Social Desirability Scale. The questionnaire was internally consistent (α=0.89–0.96) and its stability was good (intraclass correlation coefficients=0.73–0.82).

Conclusions

The Greek translation of the Pain Beliefs and Perceptions Inventory is a reliable and valid instrument to evaluate Greek patients with chronic pain.

Multidisciplinary program based on early management of psychological factors reduces disability of patients with subacute low back pain. Results of a randomised controlled study with one year follow-up

BACKGROUND

Multidisciplinary rehabilitation induces disability improvement, pain reduction and favours return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials.

AIM

To test the effect of a multidisciplinary rehabilitative programme incorporating cognitivebehavioural interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent.

DESIGN

Randomised parallel-group superiority-controlled trial.

SETTING

Outpatient rehabilitation hospital.

POPULATION

150 patients with subacute LBP.

METHODS

Patients were assigned randomly to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure.

RESULTS

Significant group (p<0.001), time (p=0.002), and time-by-group interaction (p<0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favour of the experimental group. A significant interaction effect (p<0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up.

CONCLUSIONS

The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year.

CLINICAL REHABILITATION IMPACT

Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioural and motor lasting changes.

Low Back Pain-Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non-English-Speaking Populations: Systematic Review and Meta-Analysis

OBJECTIVES

This systematic review and meta-analysis examined relationships between low back pain (LBP)-related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non-English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods.

RESULTS

Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = -0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = -0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire-Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion.

DISCUSSION

LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non-English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients' quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.

Portuguese Version of the Pain Beliefs and Perceptions Inventory: A Multicenter Validation Study

BACKGROUND

We aimed to perform the translation, cultural adaptation, and validation of the Pain Beliefs and Perceptions Inventory (PBPI) for the European Portuguese language and chronic pain population.

METHODS

This is a longitudinal multicenter validation study. A Portuguese version of the PBPI (PBPI-P) was created through a process of translation, back translation, and expert panel evaluation. The PBPI-P was administered to a total of 122 patients from 13 chronic pain clinics in Portugal, at baseline and after 7 days. Internal consistency and test-retest reliability were assessed by Cronbach's alpha (α) and intraclass correlation coefficient (ICC). Construct (convergent and discriminant) validity was assessed based on a set of previously developed theoretical hypotheses about interrelations between the PBPI-P and other measures. Exploratory and confirmatory factor analyses were performed to test the theoretical structure of the PBPI-P.

RESULTS

The internal consistency and test-retest reliability coefficients for each respective subscale were α = 0.620 and ICC = 0.801 for mystery; α = 0.744 and ICC = 0.841 for permanence; α = 0.778 and ICC = 0.791 for constancy; and α = 0.764 and ICC = 0.881 for self-blame. Exploratory and confirmatory factor analysis revealed a four-factor structure (performance, constancy, self-blame, and mystery) that explained 63% of the variance. The construct validity of the PBPI-P was shown to be adequate, with more than 90% of the previously defined hypotheses regarding interrelations with other measures confirmed.

CONCLUSION

The PBPI-P has been shown to be adequate and to have excellent reliability, internal consistency, and validity. It may contribute to a better pain assessment and is suitable for research and clinical use.