1
|
Kinnie KR, Vance DE, Patrician PA, Billings R, Aroke EN. Chronic Pain Resilience Across Clinical Populations: A Concept Analysis. Pain Manag Nurs 2024:S1524-9042(24)00140-1. [PMID: 38849234 DOI: 10.1016/j.pmn.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/10/2024] [Accepted: 03/31/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Chronic pain resilience is a concept that is frequently used in research but lacks theoretical clarity. Understanding chronic pain resilience is germane to developing interventions to improve it and the overall quality of life among individuals with chronic pain. AIMS To uncover and clarify the unique characteristics of the concept of chronic pain resilience. DESIGN A concept analysis using Rodgers' evolutionary method. METHODS Full-text articles published after 2000 in English were used to inform the concept analysis. Scopus, PubMed, PsychINFO, Embase, and CINAHL Plus with Full Text were utilized for literature searches. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, and consequences. RESULTS The search yielded 31 articles that were used in the analysis. The key attributes of chronic pain resilience included engagement in meaningful activities despite pain, maintaining positive psychological homeostasis, buffering against negative mental outcomes, seeking support, and self-empowerment. After considering surrogate terms, antecedents, attributes, and consequences, chronic pain resilience may be defined as the development of the capacity to successfully adapt to chronic pain. This adaptation results in a move toward optimal social, physical, mental, and behavioral functioning by balancing negative and positive psychosocial factors, despite the additional challenges brought about by living with chronic pain.
Collapse
Affiliation(s)
- Kiari R Kinnie
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | | | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL
| | - Edwin N Aroke
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
2
|
Haghshenas H, Shaygan M, Pasyar N, Rambod M. Explaining the Components of Resilience in Patients with Chronic Pain: A Qualitative Content Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:343-351. [PMID: 39100397 PMCID: PMC11296593 DOI: 10.4103/ijnmr.ijnmr_327_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/30/2023] [Accepted: 01/21/2024] [Indexed: 08/06/2024]
Abstract
Background Resilience is a psychological trait and a protective factor that plays a vital role in coping with Chronic Pain (CP). Despite its importance, research has yet to fully clarify the concept and components of resilience in patients with CP. Accordingly, the present study aims to explain the components of resilience in patients with CP. Materials and Methods The current qualitative study used a conventional content analysis methodology. The research population included all patients with CP who were referred to clinics affiliated with Shiraz University of Medical Sciences (south of Iran) from August 2021 to August 2022. Participants were selected using the purposive sampling method. In-depth semi-structured interviews were conducted with 20 participants to collect information. Data analysis was conducted using MAXQDA 2020 software in conjunction with data collection efforts. Results Generally, in the current study, 30 sub-sub-categories, 11 sub-categories, and five main categories were extracted as components of resilience in patients with CP. The main categories of resilience against CP included the following: 1. emotional self-regulation, 2. psychological flexibility, 3. self-care, 4. appeal to religion-spirituality, and 5. internal resources and individual competencies. Conclusions The present study highlights the different physical, mental, and religious-spiritual strategies that may contribute to resilience against pain. The resilience components identified in this study provide a foundation for healthcare professionals, particularly nurses, to design and implement diverse pain management strategies that enhance adjustment to CP conditions.
Collapse
Affiliation(s)
- Hajar Haghshenas
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nilofar Pasyar
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
3
|
Boyse JB, Sharpe L, Richmond B, Dear B, Dudeney J, Sesel AL, Menzies RE. Benign or painful? The interpretation of pain and fear of progression in rheumatoid arthritis. Pain 2024; 165:838-847. [PMID: 37889599 DOI: 10.1097/j.pain.0000000000003081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023]
Abstract
ABSTRACT People with chronic pain tend to interpret ambiguous information as health-related, more so than people without. In this study, we aimed to investigate whether people with rheumatoid arthritis (RA) exhibit this interpretation bias and whether it is associated with fear of disease progression (FoP). The interpretation biases of people with RA (n = 164) were compared with an age- and gender-matched control group. We hypothesized that (1) people with RA would have larger interpretation biases than people without; (2) those who scored in the clinical range for FoP would have larger interpretation bias than those who did not; (3) interpretation bias would moderate the relationship between pain severity and FoP; and (4) interpretation bias would explain variance in FoP above and beyond other established predictors. Our results confirmed that people with RA were more likely to interpret ambiguous information as health-related compared with people without RA. This effect was more pronounced for the RA subgroup with clinically significant FoP than those scoring in the normal range. We did not find evidence to suggest interpretation bias moderated the relationship between pain and FoP or that FoP added to the variance of other known predictors. Our results indicate that interpretation bias is common amongst people with RA and is associated with FoP. Further research is required to illuminate the exact nature of this relationship.
Collapse
Affiliation(s)
- Jack B Boyse
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Bethany Richmond
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Blake Dear
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Joanne Dudeney
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Amy-Lee Sesel
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
4
|
Abudoush AN, Poliakoff E, Panagioti M, Hodkinson A, Husain N. Investigating attention toward pain-related cues in an Arabic-speaking population with and without chronic pain. Exp Brain Res 2024:10.1007/s00221-024-06789-9. [PMID: 38424370 DOI: 10.1007/s00221-024-06789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
There is some evidence for attentional biases in individuals with chronic pain (CP). Cultural and linguistic differences might affect the manifestation of these processes across populations. However, such attentional biases have not been explored in the Arabic-speaking population. The current study investigated these attentional biases and possible associations with resilience. Two matched groups of Arabic-speaking participants with (58) and without (58) CP were recruited from Jordan and the United Kingdom. They completed emotionally modified versions of the Posner cueing and Stroop tasks, alongside questionnaires. Significant group differences were found for the Posner task, with the CP group exhibiting disengagement revealed by the inhibition of return (IOR) effect for sensory pain-related cues compared to delayed disengagement for the other cue types. The control group showed IOR across cue types. No group differences were found on the Stroop task. The CP group had lower resilience scores than healthy controls, and resilience moderated performance on the Posner task. The study provides preliminary evidence about the attentional processes in the Arabic population; the speed of disengagement is affected in the CP group with early disengagement for sensory pain-related information compared to affect pain and neutral stimuli. Furthermore, resilience levels in the CP and control group moderated the performance on the Posner task, suggesting that it influences attentional allocation. This study can help in understanding how the phenomenon of attention bias intertwines with the cultural and linguistic factors. Future research should further explore attentional dynamics across different time points in this population and the modulatory effect of resilience.
Collapse
Affiliation(s)
- Ahmad N Abudoush
- Department of Psychology, Faculty of Arts, School of Arts, The University of Jordan, Amman, Jordan.
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.
| | - Ellen Poliakoff
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Nusrat Husain
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
5
|
Grove JL, Young JR, Chen Z, Blakey SM, Beckham JC, Calhoun PS, Dedert EA, Goldston DB, Pugh MJ, Kimbrel NA. Experiential Avoidance, Pain, and Suicide Risk in a National Sample of Gulf War Veterans. Arch Suicide Res 2024; 28:295-309. [PMID: 36573028 PMCID: PMC10291004 DOI: 10.1080/13811118.2022.2160681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Pain confers risk for suicidal thoughts and behaviors. Experiential avoidance (EA), which is relevant to both pain and suicide risk, has not been studied as a potential mechanism for this relationship. The present study tested the hypothesis that pain indirectly impacts suicide risk through EA in a national sample of Gulf War veterans. METHODS Participants included a stratified random sample of United States veterans (N = 1,012, 78% male) who had served in the Gulf War region between August 1990 and July 1991. Validated scales were used to quantify levels of pain, EA, and suicide risk. RESULTS Regression analyses indicated independent associations between pain, EA, and suicide risk; moreover, the association between pain and suicide risk was no longer significant once EA was included in model. Bootstrapping analyses confirmed that EA partially accounted for the cross-sectional association between pain and suicide risk, independent of common co-occurring problems, such as depression, PTSD, and alcohol use disorder symptoms. CONCLUSIONS EA could be a key modifiable risk factor to target in people experiencing pain.
Collapse
Affiliation(s)
- Jeremy L. Grove
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Jonathan R. Young
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Zhengxi Chen
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Shannon M. Blakey
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- Dr. Shannon Blakey is now affiliated with RTI International
| | - Jean C. Beckham
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Patrick S. Calhoun
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
| | - Eric A. Dedert
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
| | - David B. Goldston
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Mary J. Pugh
- VA Salt Lake City Healthcare System
- University of Utah, School of Medicine, Department of Medicine
| | - Nathan A. Kimbrel
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
| |
Collapse
|
6
|
Ionescu D, Iacob CI, Brehar FM, Avram E. The role of catastrophizing and basic psychological needs satisfaction on health-related quality of life and pain in patients with lumbar disc herniation. Front Psychol 2023; 14:1147254. [PMID: 37425150 PMCID: PMC10323192 DOI: 10.3389/fpsyg.2023.1147254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Lumbar disc herniation (LDH) is one of the most common conditions associated with functional disability, affecting patients' quality of life (QOL). Disability can be affected by cognitive factors, such as pain catastrophizing. Similarly, unfulfilled basic psychological needs (i.e., autonomy, competence, relatedness) are associated with biases in pain perception and QOL. Using the fear-avoidance model and the self-determination theory, this study investigates: (1) the separate contribution of pain-related variables and basic psychological needs satisfaction in predicting QOL in patients proposed for LDH surgery; (2) pre- and post-surgical differences in pain catastrophizing and basic psychological needs satisfaction. Methods First, we used hierarchical regression on 193 patients (Mage = 46.10, SDage = 11.40) to identify predictors of QOL. Second, we performed paired t-tests on 55 patients to investigate pre- and post-surgical differences in pain catastrophizing and basic psychological needs satisfaction. Results Hierarchical regression showed that the model predicts 27% of the variance in QOL; medium pain level, age, pain catastrophizing, and basic psychological needs satisfaction were significant predictors. Also, pain catastrophizing significantly decreased after surgery [t (54) = 6.07, p < 0.001, Cohen's d = 0.81], but basic psychological needs satisfaction did not modify significantly. Discussion This research confirms the importance of pain perception and pain catastrophizing for LDH patients' QOL and broadens the applicability of the self-determination theory for spinal patients.
Collapse
Affiliation(s)
- Daniela Ionescu
- Department of Sociology, National School of Political and Administrative Studies, Bucharest, Romania
| | - Claudia Iuliana Iacob
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Felix Mircea Brehar
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eugen Avram
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| |
Collapse
|
7
|
Slaghmuylder Y, Lauwerier E, Pype P. Survivors' perceptions regarding the follow-up of pain complaints after breast cancer treatment: Distinct coping patterns. Front Psychol 2023; 13:1063705. [PMID: 36710732 PMCID: PMC9879359 DOI: 10.3389/fpsyg.2022.1063705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction After finishing cancer treatment, breast cancer survivors often experience both physical and psychosocial symptoms such as pain. In some, pain can persist for months or even years. Pain is a complex experience. Its occurrence and maintenance are explained through interactions between multiple factors, which are biological/physiological, psychological, and social in nature. Unaddressed needs related to this problem - such as insufficient pain relief, limited validation of the problem, and minimal physical and psychological support - may cause severe disability and negatively impact well-being and quality of life. This study investigated how breast cancer survivors perceive their (chronic) pain complaints to be addressed during follow-up care. Furthermore, we explored how they coped with the way their trajectories happened to unfold. Methods We conducted four focus groups with a total of thirty-one breast cancer survivors. Each focus group consisted of an asynchronous part with an online discussion platform and a synchronous part through video calls. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Results Narratives revealed the unmet needs of survivors and showed variability in the lived experiences of having to deal with pain. Some survivors tend to ignore the pain, while others look for solutions to reduce pain. A third coping pattern is accepting pain and its impact. Furthermore, how survivors cope with pain is influenced by intrapersonal, interpersonal, and societal processes. For example, pain-related beliefs and prejudices among healthcare providers, family, friends, colleagues, other cancer survivors, and society could possibly steer a survivor towards a certain way of coping. In these processes, the role of healthcare providers seems pivotal. For instance, when survivors do not feel heard or taken seriously by healthcare providers, their acceptance of pain can be impeded. Discussion To conclude, a person's way of coping with pain and the associated needs is dynamic and influenced by factors at multiple levels such as the intrapersonal, interpersonal and societal level. To sufficiently address the problem of pain among cancer survivors, we therefore also need actions that tackle the health care system and its stakeholders, as well as the public debate concerning cancer follow-up care.
Collapse
Affiliation(s)
- Yaël Slaghmuylder
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,*Correspondence: Yaël Slaghmuylder, ✉
| | - Emelien Lauwerier
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Pype
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
8
|
Robinson EM, Clothier PJ, Slater H, Gupta A. A scoping review on the methods of assessment and role of resilience on function and movement-evoked pain when experiencing a musculoskeletal injury. BMC Musculoskelet Disord 2022; 23:1097. [PMID: 36522734 PMCID: PMC9753293 DOI: 10.1186/s12891-022-06058-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Resilience refers to an individual's ability to maintain effective functioning, by resisting, withstanding or recovering from stressors or adversity, including pain associated with physical injury (J Clin Psychol Med Settings 28:518-28, 2021). The aim of this scoping review is to determine the role of resilience in the experience of movement-evoked pain (MEP) and return to functional activity following a musculoskeletal injury. METHODS This review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the scoping review protocol of the Joanna Briggs Institute (JBI). Five databases and one grey literature database were searched using predetermined key words and index terms to capture published and unpublished records on the topic. Two authors independently screened the title and abstract of each record, with the full-text of eligible records being reviewed. Papers were eligible for inclusion if they examined the population, concept and context of interest, were written in English and the full text was available. Data were extracted from each eligible record to guide discussion of the available literature on this topic. RESULTS Of 4771 records, 2695 articles underwent screening based on their title and abstract. After title and abstract screening 132 articles were eligible for full text review, with 24 articles included in the final analysis. This review identified that psychological resilience has primarily been investigated in the context of a range of age-related pathologies. The choice of functional and movement-evoked pain assessments in the included studies were often guided by the pathology of interest, with some being general or injury specific. CONCLUSION This scoping review identified inconsistent conclusions regarding the role of resilience in the experience of MEP and the ability to return to function for older adults with a musculoskeletal injury. This scoping review highlights the need for longitudinal research to be conducted that allows a broader age range, including younger adults, to determine if multidimensional resilience may promote recovery form musculoskeletal injury.
Collapse
Affiliation(s)
- Elise M. Robinson
- grid.1029.a0000 0000 9939 5719Western Sydney University, School of Health Sciences, PO Box 1797, Penrith, NSW 2751 Australia
| | - Peter J. Clothier
- grid.1029.a0000 0000 9939 5719Western Sydney University, School of Health Sciences, PO Box 1797, Penrith, NSW 2751 Australia
| | - Helen Slater
- grid.1032.00000 0004 0375 4078Curtin University, Curtin School of Allied Health, enAble Institute, Bentley, Australia
| | - Amitabh Gupta
- grid.1029.a0000 0000 9939 5719Western Sydney University, School of Health Sciences, PO Box 1797, Penrith, NSW 2751 Australia
| |
Collapse
|
9
|
Reyes AT, Cross CL, Manzano ERM. The Moderating Role of Resilience on Mindfulness, Experiential Avoidance, and Posttraumatic Stress Disorder (PTSD) Symptoms of College Student Veterans: A Cross-Sectional Study. Issues Ment Health Nurs 2022; 43:721-729. [PMID: 35285759 DOI: 10.1080/01612840.2022.2051104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of the study was to investigate the moderating effect of resilience on the relationship between mindfulness, experiential avoidance, and posttraumatic stress disorder (PTSD) symptom severity. A cross-sectional study design was used on a sample of 133 college student military veterans. We found a direct effect of mindfulness on PTSD and a significant mediating effect of experiential avoidance on the relationship between mindfulness and PTSD. Resilience also had a significant moderating effect on the relationship between mindfulness and PTSD. This study provides preliminary evidence on the usefulness of integrating resilience development in mindfulness-based interventions for trauma-related disorders.
Collapse
Affiliation(s)
| | - Chad L Cross
- School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | | |
Collapse
|
10
|
Sainero-Tirado G, Ramírez-Maestre C, López-Martínez AE, Esteve R. Distress intolerance and pain catastrophizing as mediating variables in PTSD and chronic noncancer pain comorbidity. Scand J Pain 2022; 23:318-325. [PMID: 35858875 DOI: 10.1515/sjpain-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/30/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Several studies have demonstrated posttraumatic stress disorder (PTSD) and chronic pain comorbidity. However, there is a lack of research on the psychological variables that might explain their co-occurrence. We investigated the mediating role of distress intolerance and pain catastrophizing in this relationship. METHODS A moderated mediation model was tested. The sample comprised 114 individuals with chronic noncancer pain (90 women and 24 men; mean age, of 60.04 years [SD=9.76]). RESULTS Catastrophizing had a significant effect on PTSD. Distress intolerance mediated catastrophizing and PTSD, and pain intensity moderated this relationship. CONCLUSIONS New insights are provided into the psychological variables that may explain PTSD and chronic noncancer pain comorbidity.
Collapse
Affiliation(s)
| | - Carmen Ramírez-Maestre
- University of Malaga: Universidad de Málaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Alicia E López-Martínez
- University of Malaga: Universidad de Málaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Rosa Esteve
- University of Malaga: Universidad de Málaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| |
Collapse
|
11
|
Saba SK, Davis JP, Prindle JJ, Castro CA, Pedersen ER. Associations between symptoms of posttraumatic stress disorder, pain, and alcohol use disorder among OEF/OIF/OND veterans. Addict Behav 2021; 122:107031. [PMID: 34237611 DOI: 10.1016/j.addbeh.2021.107031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is prevalent among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. Pain and posttraumatic stress disorder (PTSD) are highly comorbid and increase risk of AUD. Prior studies linking pain or PTSD to AUD have not explored interactions between pain and PTSD symptoms. METHODS OEF/OIF/OND veterans (N = 1230) were recruited from social media websites for a cross-sectional study of health behavior. Pain was assessed using the Pain Outcomes Questionnaire. PTSD symptoms and PTSD symptom clusters were assessed using the Posttraumatic Stress Disorder Checklist for DSM-5. AUD symptoms were assessed with the AUD Identification Test. Linear regression models were used to test for main and interaction effects in the full sample and separately by sex. RESULTS Both pain and PTSD symptoms were associated with increased AUD symptomology, though the relationship between pain and AUD was heighted at relatively low PTSD symptoms. With respect to PTSD symptom clusters, re-experiencing and negative cognitions and mood were associated with increased AUD symptomology. Interactions between pain and re-experiencing as well as pain and avoidance were revealed. Results for men mirrored the full sample, while an interaction between pain and negative cognitions and mood was associated with AUD in women. CONCLUSIONS Results highlight associations between AUD, PTSD symptoms, and pain among veterans. While the relationship between pain and AUD appeared stronger in the context of low PTSD symptoms, both pain and PTSD symptoms were associated with increased AUD. Clinicians treating veterans with AUD should address the range of potential comorbidities.
Collapse
Affiliation(s)
- Shaddy K Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34(th) St, Los Angeles, CA 90089, United States.
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Artificial Intelligence in Society, USC Institute for Addiction Science, 669 W. 34(th) St, Los Angeles, CA 90089, United States
| | - John J Prindle
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34(th) St, Los Angeles, CA 90089, United States
| | - Carl Andrew Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California Suzanne-Dworak-Peck School of Social Work, 669 W. 34(th) St, Los Angeles, CA 90089, United States
| | - Eric R Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, United States
| |
Collapse
|
12
|
The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity. J Pers Med 2021; 11:jpm11080810. [PMID: 34442454 PMCID: PMC8401554 DOI: 10.3390/jpm11080810] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.
Collapse
|
13
|
Vallejo MA, Vallejo-Slocker L, Offenbaecher M, Hirsch JK, Toussaint LL, Kohls N, Sirois F, Rivera J. Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7300. [PMID: 34299758 PMCID: PMC8307804 DOI: 10.3390/ijerph18147300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/27/2022]
Abstract
Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.
Collapse
Affiliation(s)
- Miguel A. Vallejo
- Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Laura Vallejo-Slocker
- Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Martin Offenbaecher
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Jameson K. Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA;
| | | | - Niko Kohls
- Division of Integrative Health Promotion, University of Applied Science and Arts, 96450 Coburg, Germany;
| | - Fuschia Sirois
- Department of Psychology, University of Sheffield, Sheffield S1 2LT, UK;
| | - Javier Rivera
- Rehumatology Unit, Instituto Provincial de Rehabilitación, Hospital General Universitario “Gregorio Marañón”, 28028 Madrid, Spain;
| |
Collapse
|
14
|
Ramírez-Maestre C, Esteve R, López-Martínez AE, Jensen MP, Miró J, de la Vega R. The Impairment and Functioning Inventory Revised-English version: A validation study in individuals with disabilities and bothersome pain. PM R 2021; 14:818-827. [PMID: 34181318 DOI: 10.1002/pmrj.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/14/2021] [Accepted: 06/11/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the relevance of daily function in individuals with chronic pain, few questionnaires have been designed to assess this domain in individuals with musculoskeletal pain. In addition, the Impairment and Functioning Inventory-Revised (IFI-R) is the only instrument that assesses perceived decreases in levels of daily activity after the onset of pain. OBJECTIVE To evaluate the psychometric properties of the English version of the IFI-R. DESIGN Cross-sectional study. SETTING A database of individuals with medical conditions commonly associated with chronic pain maintained by the University of Washington. PATIENTS A total of 470 individuals with chronic pain. METHODS Factorial validity was analyzed by conducting a confirmatory factor analysis via structural equation modeling. Internal consistency was evaluated by calculating Cronbach's α coefficients. Convergent validity was assessed by calculating Pearson correlation coefficients between the two scales of the IFI-R and the Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference Scale. Criterion validity was analyzed by regression analysis via structural equation modeling. MAIN OUTCOME MEASURES The English version of the IFI-R (IFI-R-EV) for individuals with chronic pain. RESULTS The IFI-R-EV consists of 30 items with two related subscales: The Daily Function subscale (α = .86). and the Impairment subscale (α = .89). A significant correlation was found between these subscales and a measure of pain interference (r's = - .33, and .35 respectively; p's < .01). We also found statistically significant associations (p < .05) between daily function and depression (β = -.14) and pain intensity (β = -.13), between impairment and depression (β = .14) and pain intensity (β = .16), and between daily function and pain acceptance (β = .14). CONCLUSIONS The findings indicate that the IFI-R-EV provides valid and reliable measures of daily function and impairment in English-speaking individuals with a disability and chronic pain. These results are consistent with those obtained with the Spanish version.
Collapse
Affiliation(s)
- Carmen Ramírez-Maestre
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jordi Miró
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
| | - Rocío de la Vega
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain
| |
Collapse
|
15
|
Maathz P, Flink IK, Engman L, Ekdahl J. Psychological Inflexibility as a Predictor of Sexual Functioning Among Women with Vulvovaginal Pain: A Prospective Investigation. PAIN MEDICINE 2020; 21:3596-3602. [PMID: 32186737 PMCID: PMC7770233 DOI: 10.1093/pm/pnaa042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Persistent vulvovaginal pain affects many women and often has adverse effects on sexual functioning. Psychological inflexibility related to pain is associated with distress and functional disability across different types of chronic pain conditions, but little is known about the role of psychological inflexibility in vulvovaginal pain. The present study examines psychological inflexibility related to pain as a predictor of sexual functioning over time among women with vulvovaginal pain. Methods Questionnaires including measures of psychological inflexibility, pain severity, and sexual functioning were administered to female university students at two points in time. One hundred thirty women with vulvovaginal pain responded to the questionnaire at baseline and at follow-up after 10 months. A multiple regression model was used to explore psychological inflexibility and pain severity as predictors of sexual functioning at follow-up. Results Higher levels of psychological inflexibility and more severe pain at baseline were associated with poorer sexual functioning 10 months later. In analysis adjusting for baseline levels of sexual functioning, psychological inflexibility was the only significant predictor of sexual functioning at follow-up. Conclusions The findings provide preliminary evidence that psychological inflexibility is associated with sexual adjustment over time among women with vulvovaginal pain and point to the relevance of further examinations of the psychological inflexibility model in the context of vulvovaginal pain.
Collapse
Affiliation(s)
- Pernilla Maathz
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Ida K Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Linnea Engman
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| |
Collapse
|
16
|
Ramírez-Maestre C, Reyes-Pérez Á, Esteve R, López-Martínez AE, Bernardes S, Jensen MP. Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176428. [PMID: 32899359 PMCID: PMC7503487 DOI: 10.3390/ijerph17176428] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023]
Abstract
Background: Psychological factors of patients may influence physicians’ decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods: A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results: Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions: The findings suggest that patient factors influence physicians’ decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions.
Collapse
Affiliation(s)
- Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
- Correspondence: ; Tel.: +34-952-13-23-89
| | - Ángela Reyes-Pérez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
| | - Rosa Esteve
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
| | - Alicia E. López-Martínez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (Á.R.-P.); (R.E.); (A.E.L.-M.)
| | - Sonia Bernardes
- Instituto Universitario de Lisboa (ISCTE-IUL), Cis-IUL, Av. das Forças Armadas, 1649-026 Lisboa, Portugal;
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, 325 9th Ave, Seattle, WA 98104, USA;
| |
Collapse
|
17
|
Ramírez-Maestre C, Esteve R, López-Martínez AE, Miró J, Jensen MP, de la Vega R. Beyond pain intensity and catastrophizing: The association between self-enhancing humour style and the adaptation of individuals with chronic pain. Eur J Pain 2020; 24:1357-1367. [PMID: 32383261 DOI: 10.1002/ejp.1583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/29/2020] [Accepted: 05/01/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many questions regarding the process by which self-enhancing humour style has an effect on chronic pain individuals' adjustment remain unanswered. The aim of the present study was to analyse the association of self-enhancing humour style with adjustment in a sample of individuals with chronic pain, over and above the role of catastrophizing and pain intensity. Adjustment was assessed using measures of depression, pain interference and flourishing. We also examined the indirect association between self-enhancing humour style and adjustment via pain acceptance. METHODS The study included 427 patients with heterogeneous chronic pain conditions. The study hypotheses were tested using three multiple linear regression analyses, one for each of the criterion variables. RESULTS Consistent with the study hypothesis, both direct and indirect associations were found between self-enhancing humour style and depressive symptoms, pain interference and flourishing via pain acceptance. CONCLUSIONS Self-enhancing humour style could potentially help individuals with chronic pain to gain perspective and distance themselves from the situation through the acceptance of pain-related negative emotions. SIGNIFICANCE Very few studies have investigated the relationship between humour styles and adjustment in chronic pain samples. The results of the current study support the idea that adaptive dispositional traits, such as patient's self- enhancing humour style, play a role in the adaptation of individuals with chronic pain. Given that the association between self-enhancing humour style and adjustment evidenced an indirect association through pain acceptance, training in the use of humour, as individuals with self-enhancing humour style do, might be a useful addition to ACT treatment.
Collapse
Affiliation(s)
- Carmen Ramírez-Maestre
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Rosa Esteve
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Alicia E López-Martínez
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, Málaga, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
18
|
Yang Z, Bateer. Identifying pain perceptual biases related to fear of pain and threat in a pain-free sample. Eur J Pain 2020; 24:1084-1093. [PMID: 32133705 DOI: 10.1002/ejp.1553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND The association between fear of pain (FOP) and pain intensity has remained unclear. This study aimed to examine whether highly pain-fearful participants showed pain perceptual biases to general painful stimulus or to specific threatening painful stimulus. METHODS Fifty-nine undergraduates were recruited into low (n = 30) and high (n = 29) FOP groups and completed a threatening pain perception task with two tasks. Task 1 assessed pain perceptual biases by calculating the percentage of near-threshold pain stimulus judged as painful and assessing the average pain intensity ratings to those painful stimuli. Task 2 assessed pain perceptual biases by measuring pain ratings to each single threshold (low intensity) and twice-threshold (high intensity) pain stimulus. RESULTS Results from task 1 indicated that higher FOP levels were associated with higher pain sensitivity when pain was appraised as a threat, reflected as high FOP group reporting higher pain intensity to those stimuli judged as painful in high threat condition than in low threat condition. Consistently, results from task 2 observed that when noxious stimulus intensity increased to threshold pain and twice threshold pain levels, high FOP group also generally reported higher pain intensity in high threat condition than in low threat condition. However, for both tasks, no such threat level differences were observed in low FOP group. CONCLUSIONS The current research emphasized that participants with higher FOP level showed pain perceptual biases to specific threatening painful stimulus. Threat appraisal of pain played a key role in the positive association between pain-related fear and pain perceptual biases. SIGNIFICANCE The findings highlight the modulatory influence of threat appraisal of pain in the positive association between pain-related fear and pain perceptual biases.
Collapse
Affiliation(s)
- Zhou Yang
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China.,Faculty of Psychology, Southwest University, Chongqing, China
| | - Bateer
- Faculty of Psychology, Southwest University, Chongqing, China
| |
Collapse
|
19
|
Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Pain-Related Fear, Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2019; 20:1394-1415. [DOI: 10.1016/j.jpain.2019.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/01/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022]
|
20
|
Ravn SL, Vang ML, Vaegter HB, Andersen TE. Pain-Related Acceptance as a Mediator in the Fear Avoidance Model of Chronic Pain: A Preliminary Study. PAIN MEDICINE 2019; 19:1764-1771. [PMID: 29036699 DOI: 10.1093/pm/pnx223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective The fear avoidance model has served as a popular, heuristic model in explaining the transition from acute to chronic pain. In addition, the significance of pain-related acceptance in chronic pain development and adjustment is underlined in a vast number of empirical studies. The objective of the current preliminary study was to investigate pain-related acceptance as a mediator within the key cognitive relationships proposed by the fear avoidance model of chronic pain. Materials and Methods. In a cross-sectional design, bodily pain, pain catastrophizing, fear avoidance beliefs, and pain-related acceptance were assessed by questionnaires in 125 chronic pain patients in a Danish multidisciplinary pain center. Mediation analyses were performed to test the effect of pain-related acceptance on bodily pain, pain catastrophizing, and fear avoidance beliefs. Results Medium-sized correlations were found between all outcomes. Mediation analyses revealed that pain-related acceptance was a significant mediator between 1) bodily pain and pain catastrophizing and 2) pain catastrophizing and fear avoidance beliefs after controlling for bodily pain. Furthermore, pain-related acceptance accounted for a large proportion in both associations (82.2% and 56.1%). Conclusions The results suggest that pain-related acceptance is a prominent psychological mechanism within the key cognitive associations of the fear avoidance model, which predicts a certain path of cognitive, emotional, and behavioral factors in the development and maintenance of chronic pain. This proposes pain-related acceptance to be an important mechanism that possibly counteracts the negative reactions of pain catastrophizing and fear avoidance beliefs. These findings should be investigated further and could potentially be an important place to intervene clinically in order to counteract the development and/or maintenance of chronic pain.
Collapse
Affiliation(s)
- Sophie Lykkegaard Ravn
- Departments of Psychology.,The Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | | | - Henrik Bjarke Vaegter
- Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Anesthesiology and Intensive Care Medicine, Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
21
|
Ramírez-Maestre C, Esteve R, López-Martínez AE, Serrano-Ibáñez ER, Ruiz-Párraga GT, Peters M. Goal Adjustment and Well-Being: The Role of Optimism in Patients with Chronic Pain. Ann Behav Med 2019; 53:597-607. [PMID: 30184082 PMCID: PMC6546937 DOI: 10.1093/abm/kay070] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Chronic pain directly or indirectly interferes with valued personal goals. Goal adjustment plays a central role in patients’ adaptation. Studies on the relationship between optimism and goal regulation have shown that people with high dispositional optimism adjust their goals in a flexible way, and that flexible goal adjustment promotes quality of life. Purpose The aim of this study was to analyze the relationship among optimism, goal adjustment, and adaptation in patients with chronic pain. Methods A sample of 258 patients with chronic musculoskeletal pain completed questionnaires on optimism, reengagement, disengagement, flexibility, tenacity, rumination, purpose in life, well-being, pain intensity, daily functioning, and impairment. Results Structural equation modeling analysis showed that optimism had a positive association with reengagement, flexibility, and tenacity, and a negative association with disengagement. Disengagement was positively associated with rumination, whereas reengagement, flexibility, and tenacity were associated with higher levels of purpose in life, which were strongly associated with adaptation in patients with chronic pain. Conclusions This study supports the conclusions of previous research on the role of goal adjustment as a mediator variable between optimism and well-being.
Collapse
Affiliation(s)
- Carmen Ramírez-Maestre
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Alicia E López-Martínez
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Elena R Serrano-Ibáñez
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Gema T Ruiz-Párraga
- Universidad de Málaga, Andalucía Tech, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Málaga, Spain
| | - Madelon Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, MD Maastricht, Netherlands
| |
Collapse
|
22
|
A Network Analysis of the Links Between Chronic Pain Symptoms and Affective Disorder Symptoms. Int J Behav Med 2019; 26:59-68. [PMID: 30377989 DOI: 10.1007/s12529-018-9754-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND A range of psychological constructs, including perceived pain, self-efficacy, and pain avoidance, have been proposed to account for the comorbidity of chronic pain and affective disorder symptoms. Despite the likely inter-relation among these constructs, few studies have explored these predictors simultaneously. As such, the relative contributions of these psychological influences remain an open question. PURPOSE The present study uses a novel, network model approach to help to identify the key psychological contributors to the pain-affective disorder link. METHOD A cross-sectional design was implemented. The sample comprised 169 individuals with chronic pain (Mage 49.82; range 22-80 years; 58% female) admitted to a metropolitan chronic pain clinic in Victoria, Australia. Participants completed self-report measures of anxiety, depressive, and pain symptoms, pain self-efficacy, fear avoidance beliefs, perceived control, and pain-related disability. RESULTS Network analysis identified self-efficacy, fear avoidance, and perceived disability as key constructs in the relationship between pain and affective disorder symptoms, albeit in different ways. While self-efficacy appeared to have direct links to other constructs in the network model, fear avoidance and perceived disability seemed to function more as mediators, linking other constructs in the model. Perceived control and anxiety were found to be less influential in the model. CONCLUSIONS Present findings identify self-efficacy, fear avoidance, and perceived disability as plausible candidate variables to target to disrupt the link between pain experience and affective disorder symptoms. However, further testing with longitudinal designs is needed to confirm this.
Collapse
|
23
|
Pain Acceptance and Its Associated Factors among Cancer Patients in Mainland China: A Cross-Sectional Study. Pain Res Manag 2019; 2019:9458683. [PMID: 30906486 PMCID: PMC6393889 DOI: 10.1155/2019/9458683] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/20/2019] [Indexed: 11/17/2022]
Abstract
Background Pain acceptance is associated with disability, pain interference, depression, and anxiety. Few studies have been conducted on the acceptance of cancer pain and its correlates. Objectives The aim of this study was to examine the level and correlates of pain acceptance in cancer patients from mainland China. Setting and Participants The study comprised 156 cancer patients in a tertiary cancer hospital in Hunan Province of China. Design The study is based on a cross-sectional survey design. Subjects and Methods The 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) was completed by 156 cancer patients with chronic pain from a tertiary cancer hospital. Demographics, pain, and negative mood assessed by the Hospital Anxiety and Depression Scale (HADS) were explored in relation to the CPAQ-8 scores using descriptive univariate analysis. Results For the 156 patients, the mean CPAQ-8 score was 25.99 (SD = 8.56; range: 9 to 44). The scores were associated with age, gender, marital status, pain duration, number of pain sites, and duration of taking analgesics. The total scores on the CPAQ-8 and its two subscales (activity engagement and pain willingness) were negatively correlated with the HADS scores. Conclusions The findings suggest that the prevalence of pain acceptance is relatively low for Chinese cancer patients. The cancer pain acceptance is affected by age, gender, pain duration, number of pain sites, and duration of taking analgesics. The acceptance of cancer pain is negatively correlated with depression and anxiety. Therefore, patients with risk factors for low pain acceptance should receive more attention in Chinese medical settings.
Collapse
|
24
|
Difficulties in emotion regulation and chronic pain-related disability and opioid misuse. Addict Behav 2018; 87:200-205. [PMID: 30053706 DOI: 10.1016/j.addbeh.2018.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/19/2018] [Accepted: 07/19/2018] [Indexed: 02/03/2023]
Abstract
Risk for opioid misuse is a crucial consideration for patients with chronic pain, given the recent high rates of opioid-related deaths in the U.S. Emotion regulation difficulties may be associated with chronic pain outcomes such as opioid misuse, but may also be amenable to intervention. The aim of this study was to examine associations between difficulties with emotion regulation and disability and risk for opioid misuse among Appalachian chronic pain patients. The Difficulties in Emotion Regulation scale (DERS-18), Pain Disability Index (PDI), Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R), and Current Opioid Misuse Measure (COMM) were collected from 149 patients (age 25-80, 59% female) presenting to a behavioral medicine department for evaluation. The extent to which DERS-18 scores predict risk for opioid misuse and disability was examined via hierarchical regression, logistic regression, and receiver operating characteristic (ROC) curve analyses. DERS-18 scores account for 45% of variance in SOAPP-R, 36% in COMM scores, and 11% in PDI scores. A one-point increase in DERS-18 score is associated with 19% greater odds of being at risk for misuse as measured by the SOAPP-R, and 16% greater odds on the COMM. In ROC analyses, the DERS-18 is a good predictor of risk on the SOAPP-R (AUC = .85) and COMM (.83), with cut-off scores in the mid-30s exhibiting good sensitivity and specificity. Difficulties in emotion regulation are associated with poorer functioning and with greater risk of opioid misuse in this population, but may be amenable to intervention.
Collapse
|
25
|
|
26
|
Agarwal V. Re‐conceptualizing pain through patient‐centred care in the complementary and alternative medicine therapeutic relationship. J Adv Nurs 2018; 74:2406-2415. [DOI: 10.1111/jan.13734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/23/2018] [Accepted: 05/15/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Vinita Agarwal
- Department of Communication Arts Fulton School of Liberal Arts Salisbury University Ayurvedic Wellness Educator Salisbury Maryland
| |
Collapse
|
27
|
Bérubé M, Gélinas C, Martorella G, Feeley N, Côté J, Laflamme GY, Rouleau DM, Choinière M. Development and Acceptability Assessment of a Self-Management Intervention to Prevent Acute to Chronic Pain Transition after Major Lower Extremity Trauma. Pain Manag Nurs 2018; 19:671-692. [PMID: 29778755 DOI: 10.1016/j.pmn.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 03/15/2018] [Accepted: 04/04/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Transition from acute to chronic pain often occurs after major lower extremity trauma. Chronic pain has been found to negatively affect daily functioning, including the capacity to work and quality of life. Empirical data and an acceptability assessment were used to develop a self-management intervention aimed at preventing acute to chronic pain transition after major lower extremity trauma (i.e., iPACT-E-Trauma). METHODS Evidence from previous studies on preventive self-management interventions, combined with a biopsychosocial conceptual framework and clinical knowledge, helped define the key features of the preliminary version. Then a mixed-methods design was used to assess the acceptability of iPACT-E-Trauma by clinicians and patients. RESULTS The key features of the preliminary version of iPACT-E-Trauma were assessed as acceptable to very acceptable by clinicians and patients. After clinician assessment, intervention activities were simplified and session duration was reduced. Patient acceptability assessment of iPACT-E-Trauma led to the tailoring of key intervention features, based on determinants such as pain intensity and the implementation of self-management behaviors between intervention sessions. Web-based sessions were also developed to facilitate iPACT-E-Trauma delivery. CONCLUSION This study outlines the process involved in the development of an intervention to prevent chronic pain in patients with lower extremity trauma. Relevant information is provided to nurses and interdisciplinary teams on a self-management intervention to prevent the transition from acute to chronic pain in the trauma population.
Collapse
Affiliation(s)
- Mélanie Bérubé
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada; Centre for Nursing Research, Jewish General Hospital, Montréal, Québec, Canada
| | | | - Nancy Feeley
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada; Centre for Nursing Research, Jewish General Hospital, Montréal, Québec, Canada
| | - José Côté
- Faculté des Sciences Infirmières, Université de Montréal and Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | | | - Manon Choinière
- Department of Anesthesiology, Université de Montréal, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
28
|
Du S, Hu L, Bai Y, Dong J, Jin S, Zhang H, Zhu Y. The Influence of Self-Efficacy, Fear-Avoidance Belief, and Coping Styles on Quality of Life for Chinese Patients with Chronic Nonspecific Low Back Pain: A Multisite Cross-Sectional Study. Pain Pract 2018; 18:736-747. [PMID: 29171174 DOI: 10.1111/papr.12660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND As a bio-psycho-social issue, chronic low back pain (CLBP) has been a significant topic in health management, and patients' quality of life (QOL) is gaining extensive attention. Self-efficacy, pain fear-avoidance belief (FAB), and coping styles play important roles in the QOL of CLBP patients. However, it remains unclear how self-efficacy and FAB influence QOL through specific coping styles. This study aimed to explore the influencing paths of self-efficacy, FAB, and coping styles on the QOL of patients with CLBP. METHODS This study relies on a multisite, cross-sectional design involving 221 CLBP patients. Stepwise multiple regression and structural equation modeling were employed. RESULTS CLBP patients lived with a poor global QOL. Self-efficacy played a direct, positive role in predicting QOL for patients with CLBP (β = 0.35), and it also played an indirect, positive role in predicting QOL (β = 0.19) through active coping styles (β = 0.31). FAB played a direct, negative role in predicting QOL (β = -0.33), and it also played an indirect, negative role in predicting QOL (β = -0.32) through passive coping styles (β = 0.32). CONCLUSIONS Self-efficacy and FAB are both directly and indirectly related to global QOL, and coping styles are important mediating variables. Self-efficacy and active coping are protective factors for the QOL of CLBP patients, while FAB and passive coping are risk factors. Health education strategies are recommended by medical personnel to enhance CLBP patients' pain self-efficacy, decrease pain FAB, and modify pain coping styles, so that their global QOL can be improved.
Collapse
Affiliation(s)
- Shizheng Du
- School of Nursing, Fudan University, Shanghai, China.,School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingli Hu
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yamei Bai
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianshu Dong
- Shanghai Health Promotion Center, Shanghai, China
| | - Shengji Jin
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Heng Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Zhu
- Department of General Surgery, The First People's Hospital of Taicang, Taicang, China
| |
Collapse
|
29
|
Ramírez-Maestre C, Esteve R, Ruiz-Párraga G, Gómez-Pérez L, López-Martínez AE. The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain. Int J Behav Med 2017; 24:239-248. [PMID: 27757840 DOI: 10.1007/s12529-016-9600-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability. METHOD Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability. RESULTS A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability. CONCLUSION Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.
Collapse
Affiliation(s)
- C Ramírez-Maestre
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain.
| | - R Esteve
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
| | - G Ruiz-Párraga
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
| | - L Gómez-Pérez
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
| | - A E López-Martínez
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, Spain
| |
Collapse
|
30
|
Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment. Fertil Steril 2017; 108:679-686. [DOI: 10.1016/j.fertnstert.2017.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/19/2022]
|
31
|
Bérubé M, Gélinas C, Choinière M, Feeley N, Martorella G, Parent S, Streiner DL. The effect of psychological interventions on the prevention of chronic pain in adults: a systematic review protocol. Syst Rev 2017; 6:190. [PMID: 28934981 PMCID: PMC5609012 DOI: 10.1186/s13643-017-0583-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 09/14/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Numerous psychological risk and protective factors have been identified as contributing to or preventing the development of the prevalent issue of chronic pain. Systematic reviews of studies on psychological interventions that tackle these factors have shown limited effects on chronic pain. Therefore, implementing psychological interventions before pain becomes chronic has been put forward. However, the efficacy of such interventions in preventing the transition from acute to chronic pain has not yet been systematically assessed. METHODS The aims of this systematic review are to assess the effects of psychological interventions applied in the acute pain phase on pain severity as well as on physical, psychological, and social functions at 3 months and beyond. Randomized controlled trials including psychological intervention as a treatment of primary interest and participants with pain of less than 3 months duration will be considered. The following comparisons will be undertaken: psychological interventions with (1) standard treatment, (2) information, (3) waiting-list, and (4) active treatment. The primary outcome will be pain severity using indicators such the presence or absence of pain and self-report measures such as the numeric pain intensity rating scale. Secondary outcomes will include pain-related disability, mood, coping with pain, quality of life, health care utilization, and work capability. A systematic review of English and French articles in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials will be conducted without date restriction. Extracted data will include demographics and clinical characteristics, sample size, intervention and control group types, assessment tools used, time interval of measurement, fidelity of the intervention, and attrition rate. Standardized mean differences (SMD) and risk ratios with 95% confidence intervals (CI) will be used to assess treatment effects. DISCUSSION This systematic review is the first in examining the effects of psychological interventions implemented in the acute pain phase with the objective of preventing chronic pain. Results of this systematic review could provide information on psychological intervention characteristics that are most helpful for individuals with pain and guidance as to when such interventions should be applied in the continuum of care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049312.
Collapse
Affiliation(s)
- Mélanie Bérubé
- Centre Intégré Universitaire du Nord de l'Île-de-Montréal (Hôpital du Sacré-Cœur de Montréal) and Ingram School of Nursing, McGill University, 5400 Boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.
| | - Céline Gélinas
- Ingram School of Nursing, McGill University and Centre for Nursing Research, Jewish General Hospital, 3506 University Street, Montreal, Canada
| | - Manon Choinière
- Department of Anesthesiology, Centre de recherche du Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Saint-Antoine Building, 850 Saint-Denis Street, Montréal, H2X 0A9, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University and Centre for Nursing Research, Jewish General Hospital, 3506 University Street, Montreal, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, USA
| | - Stefan Parent
- Centre de recherche du Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, H3T 1C5, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Canada
| |
Collapse
|
32
|
Karademas EC, Karekla M, Flouri M, Vasiliou VS, Kasinopoulos O, Papacostas SS. The impact of experiential avoidance on the relations between illness representations, pain catastrophising and pain interference in chronic pain. Psychol Health 2017; 32:1469-1484. [DOI: 10.1080/08870446.2017.1346193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | | | | | | | | |
Collapse
|
33
|
Bendayan R, Ramírez-Maestre C, Ferrer E, López A, Esteve R. From acute to chronic back pain: Using linear mixed models to explore changes in pain intensity, disability, and depression. Scand J Pain 2017; 16:45-51. [PMID: 28850411 DOI: 10.1016/j.sjpain.2017.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/03/2017] [Accepted: 02/21/2017] [Indexed: 02/05/2023]
Abstract
Abstract
Background/aims
This longitudinal study investigated the pattern of change in pain intensity, disability, and depression in 232 chronic pain patients who were followed up for 2 years since pain onset. Most studies that have investigated changes in these variables over time have used participants who had already been in pain for more than 3 months. Few studies have followed up individuals from the acute phase onward and such studies used traditional statistical methods that cannot identify transition points over time or measure inter-individual variability.
Methods
We followed up individuals with chronic pain from pain onset up to 18 months and we examined their pain intensity, disability and depression trajectories using a modelling approach that allows to account for between and within-individual variability. We compared three patterns of change based on theoretical criterions: a simple linear growth model; a spline model with a 3-month transition point; and a spline model with a 6-month transition point. Time with pain was selected as time metric to characterise the change in these variables in the transition from acute to chronic pain. Sex and age differences were also examined.
Results
The results showed that the pain intensity trajectory was best represented by the spline model with a 3-month transition point, whereas disability and depression were best explained by linear growth models. There were sex differences at intercept level in all the models. There were age differences at baseline for pain intensity. No sex or age differences were found for the slope.
Conclusions
Pain intensity decreased in the first 3 months but underwent no further change. Disability and depression slightly but constantly decreased over time. Although women and older individuals are more likely to report higher pain intensity or pain-related disability in the first three months with pain, no differences by sex or age appear to be associated with the changes in pain intensity, depression and disability through the process of chronification.
Implications
Our findings suggest that pain chronification could be considered a continuous process and contribute to the ongoing discussion on the utility of standard classifications of pain as acute or chronic from a clinical point of view. Clinical and intervention decisions based in these standard classifications should consider the differences in the trajectories of pain related variables over time. In addition, this article illustrates a statistical procedure that can be of utility to pain researchers.
Collapse
Affiliation(s)
- Rebecca Bendayan
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain; MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, United Kingdom.
| | - Carmen Ramírez-Maestre
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain
| | - Emilio Ferrer
- Department of Psychology, University of California, Davis, One Shields Ave., Davis, CA 95616-8686, United States
| | - Alicia López
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain
| | - Rosa Esteve
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Facultad de Psicologia, Campus de Teatinos s/n, Malaga 29071, Spain
| |
Collapse
|
34
|
Bérubé M, Gélinas C, Martorella G, Côté J, Feeley N, Laflamme GY, Rouleau D, Choinière M. A Hybrid Web-Based and In-Person Self-Management Intervention to Prevent Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): Protocol for a Pilot Single-Blind Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e125. [PMID: 28652226 PMCID: PMC5504342 DOI: 10.2196/resprot.7949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 01/08/2023] Open
Abstract
Background Acute pain frequently transitions to chronic pain after major lower extremity trauma (ET). Several modifiable psychological risk and protective factors have been found to contribute to, or prevent, chronic pain development. Some empirical evidence has shown that interventions, including cognitive and behavioral strategies that promote pain self-management, could prevent chronic pain. However, the efficacy of such interventions has never been demonstrated in ET patients. We have designed a self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma). Objective This pilot randomized controlled trial (RCT) aims to evaluate the feasibility and research methods of the intervention, as well as the potential effects of iPACT-E-Trauma, on pain intensity and pain interference with daily activities. Methods A 2-arm single-blind pilot RCT will be conducted. Participants will receive the iPACT-E-Trauma intervention (experimental group) or an educational pamphlet (control group) combined with usual care. Data will be collected at baseline, during iPACT-E-Trauma delivery, as well as at 3 and 6 months post-injury. Primary outcomes are pain intensity and pain interference with daily living activities at 6 months post-injury. Secondary outcomes are pain self-efficacy, pain acceptance, pain catastrophizing, pain-related fear, anxiety and depression symptoms, health care service utilization, and return to work. Results Fifty-three patients were recruited at the time of manuscript preparation. Comprehensive data analyses will be initiated in July 2017. Study results are expected to be available in 2018. Conclusions Chronic pain is an important problem after major lower ET. However, no preventive intervention has yet been successfully proven in these patients. This study will focus on developing a feasible intervention to prevent acute to chronic pain transition in the context of ET. Findings will allow for the refinement of iPACT-E-Trauma and methodological parameters in prevision of a full-scale multi-site RCT. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 91987302; http://www.controlled-trials.com/ISRCTN91987302 (Archived by WebCite at http://www.webcitation.org/6rR8G2vMs)
Collapse
Affiliation(s)
- Mélanie Bérubé
- Centre Integré Universitaire du Nord de l'Île de Montréal, Departments of Trauma and Nursing, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Céline Gélinas
- Center for Nursing Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Géraldine Martorella
- Tallahassee Memorial HealthCare Center for Research and Evidence Based Practice, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - José Côté
- Centre de recherche, Centre hospitalier de l'Université de Montréal, Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Nancy Feeley
- Center for Nursing Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - George-Yves Laflamme
- Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Department of Surgery, Universite de Montréal, Montreal, QC, Canada
| | - Dominique Rouleau
- Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Department of Surgery, Universite de Montréal, Montreal, QC, Canada
| | - Manon Choinière
- Centre de recherche, Centre hospitalier de l'Université de Montréal, Department of Anesthesia, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
35
|
Unique Contributions of Acceptance and Catastrophizing on Chronic Pain Adaptation. Int J Behav Med 2017; 24:542-551. [DOI: 10.1007/s12529-017-9646-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
36
|
Baker TA, O'Connor ML, Krok-Schoen JL. Influence of Social and Health Indicators on Pain Interference With Everyday Activities Among Older Black and White Cancer Patients. Gerontol Geriatr Med 2017; 2:2333721415624989. [PMID: 28138484 PMCID: PMC5119878 DOI: 10.1177/2333721415624989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 11/25/2022] Open
Abstract
Objective: This prospective study aimed to determine the influence social and health factors have on pain interference with everyday activities among older patients receiving outpatient treatment services from a comprehensive cancer center. Method: Participants were surveyed on questions assessing pain interference, and social (communication), health (pain severity, comorbidities), behavioral (self-efficacy, affect), and demographic characteristics. Multivariate analyses were specified to examine determinants of pain interference, with items loading on separate cluster composites: physical interference and psychosocial interference. Results: Pain severity was a significant indicator for physical interference. Similarly, pain severity, education, self-efficacy, negative affect, and communication were predictors of psychosocial interference. Discussion: Factors defining the daily lived experiences of older adults are important in providing baseline information on functional status. This emphasizes the need to rigorously examine the association between pain, and clinical and psychosocial indicators, but more importantly indicators that contribute to the patient’s ability to perform normal everyday activities.
Collapse
|
37
|
Kroska EB. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain. Scand J Pain 2016; 13:43-58. [DOI: 10.1016/j.sjpain.2016.06.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 01/14/2023]
Abstract
Abstract
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.
Collapse
Affiliation(s)
- Emily B. Kroska
- University of Iowa , E11 Seashore Hall , Iowa City , IA 52242 , USA
| |
Collapse
|
38
|
Development of a Yellow Flag Assessment Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort. J Orthop Sports Phys Ther 2016; 46:327-43. [PMID: 26999408 DOI: 10.2519/jospt.2016.6487] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Clinical measurement, cross-sectional. Background Pain-associated psychological distress adversely influences outcomes for patients with musculoskeletal pain. However, assessment of pain-associated psychological distress (ie, yellow flags) is not routinely performed in orthopaedic physical therapy practice. A standardized yellow flag assessment tool will better inform treatment decision making related to psychologically informed practice. Objectives To describe the development of a concise, multidimensional yellow flag assessment tool for application in orthopaedic physical therapy clinical practice. Methods A 136-item yellow flag item bank was developed from validated psychological questionnaires across domains related to pain vulnerability (negative mood, fear avoidance) and resilience (positive affect/coping). Patients seeking physical therapy with neck, back, knee, or shoulder pain completed the item bank. Iterative statistical analyses determined minimal item sets meeting thresholds for identifying elevated vulnerability or low resilience (ie, upper or lower quartile, as indicated). Further item reduction yielded a concise yellow flag assessment tool to assess 11 psychological constructs measuring pain-associated psychological distress. Correlations between the assessment tool and individual psychological questionnaires were measured and compared between anatomical regions. Concurrent validity was assessed by determining variance explained in pain and disability scores by the assessment tool. Results Subjects with elevated vulnerability and decreased resilience were identified with a high degree of accuracy (minimum of 85%) using a 17-item tool. Correlations were moderate to high between the 17-item tool and individual psychological questionnaires, with no significant differences in correlations between different anatomical regions. Shorter 10- and 7-item versions of the assessment tool allow clinicians the flexibility to assess for yellow flags quickly with acceptable trade-offs in accuracy (81% and 75%, respectively). All versions of the tool explained significant additional variance in pain and disability scores (range, 19.3%-36.7%) after accounting for demographics, historical variables, and anatomical region of pain. Conclusion Concise assessment of yellow flags is feasible in outpatient physical therapy settings. This multidimensional tool advances assessment of pain-associated psychological distress through the addition of positive affect/coping constructs and estimation of full questionnaire scores. Further study is warranted to determine how this tool complements established risk-assessment tools by providing the option for efficient treatment monitoring. J Orthop Sports Phys Ther 2016;46(5):327-345. Epub 21 Mar 2016. doi:10.2519/jospt.2016.6487.
Collapse
|
39
|
Bérubé M, Choinière M, Laflamme YG, Gélinas C. Acute to chronic pain transition in extremity trauma: A narrative review for future preventive interventions (part 2). Int J Orthop Trauma Nurs 2016; 24:59-67. [PMID: 27527536 DOI: 10.1016/j.ijotn.2016.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/13/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The first part of this series of 2 articles revealed that chronic pain is an important issue post extremity trauma (ET) involving permanent biological transformations. Interventions aimed at preventing chronic pain in ET patients are therefore required. OBJECTIVE To conduct a comprehensive analysis of literature on risk and protective factors for chronic pain post-ET to guide the development of relevant preventive interventions. METHODS A narrative review of the literature was undertaken. Databases were searched to identify studies on chronic pain prognostic factors in ET patients. RESULTS Demographic, injury-related and psychological factors were shown to either contribute to or limit acute to chronic pain transition. High-intensity acute pain hasconsistently been identified as an important chronic pain risk factor. Other significant documented risk factors include: female gender, older age, less than college education, lower limb injury, symptoms of anxiety and depression and pain catastrophizing. Pain self-efficacy and pain acceptance have been shown to protect individuals against chronic pain. CONCLUSIONS This narrative review highlights factors placing ET patients at higher risk of chronic pain or protecting them against this problem. Determining how these factors could be addressed in preventive interventions is the next step before undertaking their development.
Collapse
Affiliation(s)
- Mélanie Bérubé
- Ingram School of Nursing, McGill University, 3506 University Street, Montréal H3A 2A7, Canada; Departments of Nursing, Orthopedics and Trauma, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Research Centre, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada.
| | - Manon Choinière
- Centre de recherche du Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Saint-Antoine Building, 850 Saint-Denis Street, Montréal H2X 0A9, Canada
| | - Yves G Laflamme
- Departments of Nursing, Orthopedics and Trauma, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Research Centre, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Surgery Department, Faculty of Medicine, Université de Montréal, C. P. 6128, Succursale, Centre-ville, Montréal H3C 3J7, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, 3506 University Street, Montréal H3A 2A7, Canada; Research Centre, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, 3755 Chemin, Côte-Ste-Catherine, Montréal H3T 1E2, Canada
| |
Collapse
|
40
|
Zale EL, Ditre JW. Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain. Curr Opin Psychol 2015; 5:24-30. [PMID: 25844393 DOI: 10.1016/j.copsyc.2015.03.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic pain is a significant public health concern that imposes substantial burdens on individuals and healthcare systems, and factors that contribute to the development and maintenance of pain-related disability are of increasing empirical and clinical interest. Consistent with the fear-avoidance model of chronic pain, greater pain-related fear has consistently been associated with more severe disability and may predict the progression of disability over time. Recent evidence indicates that treatments designed to reduce pain-related fear are efficacious for improving disability outcomes, and several clinical trials are currently underway to test tailored intervention content and methods of dissemination. Future research in this area is needed to identify factors (e.g., substance use, comorbid psychopathology) that may influence interrelations between pain-related fear, response to treatment, and disability.
Collapse
|
41
|
Rosenberg JC, Schultz DM, Duarte LE, Rosen SM, Raza A. Increased pain catastrophizing associated with lower pain relief during spinal cord stimulation: results from a large post-market study. Neuromodulation 2015; 18:277-84; discussion 284. [PMID: 25817755 DOI: 10.1111/ner.12287] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/19/2015] [Accepted: 02/10/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pain catastrophizing is a negative cognitive distortion to actual or anticipated pain. Our aim was to determine if greater catastrophizing has a deleterious relationship with pain intensity and efficacy outcomes in patients receiving SCS. METHODS As part of an ongoing Institutional Review Board-approved, multi-site, single arm post-market study, 386 patients were implanted with an Eon Mini™ SCS system and had follow-up visits at 3, 6, and 12 months post-implant. Outcomes collected during the study included, but were not limited to pain intensity using the numeric rating scale (NRS), patient reported pain relief (PRP), satisfaction with their SCS system, quality of life (QOL), pain catastrophizing scale (PCS) and state-trait anxiety index (STAI). RESULTS NRS scores were associated with higher PCS scores at six months (r = 0.50, p < 0.001). The PCS was a strong predictor of the NRS when controlled for known confounders. Patients with PCS ≥30 at 6-months post-implant had a lower six-month PRP (p < 0.001) and were five times more likely to report dissatisfaction with their SCS device (p < 0.001, OR = 5.46, 95% CI: 2.51-6.35). Additionally, at six months, those who were clinically catastrophizing were three times more likely to report deterioration in QOL (p < 0.002, OR = 3.12, 95% CI: 1.62-5.51). These findings were similar at the 12 months follow visit. CONCLUSIONS Our results indicate that patients with greater catastrophizing, post-implant, were more likely to report higher pain intensity and lower pain relief, quality of life and satisfaction with SCS. These results indicate that associations between pain intensity and pain-related mental health may contribute to influence the overall efficacy of SCS.
Collapse
Affiliation(s)
| | | | | | - Steven M Rosen
- Fox Chase Pain Management, Feasterville Trevose, PA, USA
| | | |
Collapse
|
42
|
A New Version of the Impairment and Functioning Inventory for Patients With Chronic Pain (IFI-R). PM R 2014; 7:455-65. [DOI: 10.1016/j.pmrj.2014.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/08/2014] [Accepted: 11/14/2014] [Indexed: 01/07/2023]
|