Unique Contributions of Acceptance and Catastrophizing on Chronic Pain Adaptation

Acceptance of Chronic Pain in Cancer Patients in Iran: the Role of Anxiety Sensitivity, Emotional Suppression, and Learned Helplessness

BACKGROUND

Acceptance of pain is one of the most significant topics in the field of chronic pain due to its influence on the adaptation and response of people. Also, chronic pain and pain caused by the progress of cancer have a high prevalence in all stages and types of cancer.

AIMS

The present study aimed to predict the acceptance of chronic pain in patients with cancer based on anxiety sensitivity and emotional suppression with the mediating role of learned helplessness.

METHODS

The current research method was descriptive-correlation and structural equation modeling. A number of patients with cancer (400), admitted to the oncology department of Imam Khomeini Hospital in Ardabil City of Iran in the second half of 2022, were selected as the convenience sample and responded to McCracker et al.'s chronic pain acceptance scale, Rees et al.'s anxiety sensitivity scale, Roger and Nasho's emotional control questionnaire, and Quinles and Nielson's learned helplessness questionnaire.

RESULTS

Based on the obtained results, the causal relationship between anxiety sensitivity, emotional suppression, learned helplessness, and acceptance of chronic pain in patients with cancer was confirmed based on various fit indices. Anxiety sensitivity, emotional suppression, and learned helplessness had a direct effect on the acceptance of chronic pain in patients with cancer. Moreover, anxiety sensitivity and emotional suppression through learned helplessness had indirect effects on pain acceptance in patients with cancer (p < .05).

CONCLUSIONS

Thus, anxiety sensitivity, emotional suppression, and learned helplessness play an essential role in the level of pain acceptance in patients with cancer, and targeting these three components through psychological treatments can be effective in the level of pain acceptance in these patients.

Can illness representations be used to understand pain experienced in breast cancer survivorship-a cross-sectional study

BACKGROUND

Chronic pain is a recognised long-term consequence associated with breast cancer and its treatment; however, it is often underdiagnosed and undertreated. This study aims to explore the associations between illness representations, chronic cancer pain, and HRQoL in women who have survived breast cancer.

DESIGN AND METHODS

A cross-sectional online survey design was used. Data from 182 women who participated in the survey were analysed.

RESULTS

Chronic cancer pain was reported by 66% of respondents. Using the BPI-SF (score 0-10), participants were categorised into one of four pain categories: no chronic pain (BPI score 0; 34.1%), mild pain (BPI score 1-3; 35.7%), moderate pain (BPI score 4-6; 25.3%), and severe pain (BPI score 7 + ; 4.9%). The main findings were that having a strong illness identity (IPQ-R subscale which assesses the number of symptoms an individual attributes to their illness) was found to be a significant predictor of pain severity (OR 1.21 (95% CI 1.07-1.37), p = 0.003). Furthermore, HRQoL was significantly associated and predictive of pain severity (OR 0.97 (95% CI 0.95-0.99), p < 0.001). An additional finding was that not being in paid work was strongly associated with being in a higher pain category (OR 5.92 (95% CI 1.84-19.05), p = 0.003).

CONCLUSIONS

The findings of this study highlight the high prevalence of chronic cancer pain experienced by this population. Results show that dimensions of illness representations are associated with chronic cancer pain experienced by breast cancer survivors. Furthermore, having a strong illness identity and HRQoL were found to be independent, significant predictors of pain severity.

IMPLICATIONS FOR CANCER SURVIVORS

These findings demonstrate that chronic pain is an unmet clinical need experienced by breast cancer survivors, which is associated with reduced overall HRQoL. Therefore, consideration is needed regarding the assessment and management of chronic pain experienced by this population.

Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme?

Background

Interdisciplinary pain management programmes, based on cognitive-behavioural principles, aim to improve physical and psychological functioning and enhance self-management in people living with chronic pain. Currently there is insufficient evidence about whether psychological, biological or social factors are predictive of positive outcomes following pain rehabilitation. This study aims to evaluate predictors of change in Brief Pain Inventory - pain interference score (BPI) in a clinical data set to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation.

Methods

A retrospective, pragmatic observational analysis of routinely collected clinical data in two pain rehabilitation programmes, Balanced Life Programme (BLP) and Get Back Active (GBA) was conducted. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in BPI. Responder analysis was also conducted.

Results

Standard regression analyses of 208 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. Hierarchical regression showed that age and sex accounted for 2.7% (BLP) and 0.002% (GBA) of the variance in change in BPI. After controlling for age and sex, the other measures explained an additional 23% (BLP) and 19% (GBA) of the variance, p = < .001 where BPI and physical performance measures were consistently statistically significant predictors, p < .05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement (p = < .0005).

Conclusions

The combination of high self-reported pain interference and better physical performance measures may be a useful indicator of who would benefit from interdisciplinary rehabilitation. Further validation of the results is required.

Race, Ethnicity, and Belief in a Just World: Implications for Chronic Pain Acceptance Among Individuals with Chronic Low Back Pain

Chronic pain acceptance is a psychological process consistently linked with improved functional outcomes. However, existing research on this construct has not considered the role of racial or ethnic background, despite growing evidence of racialized disparities in pain experience and treatment. This study aimed to examine racial differences in chronic pain acceptance, as measured by the chronic pain acceptance questionnaires (CPAQ), in a multicultural sample of individuals with chronic low back pain (N = 137-37.2% White, 31.4% Hispanic, and 31.4% Black/African American). We further sought to examine moderating effects of discrimination, pain-related perceived injustice (PI), and just world belief (JWB). Analyses consisted of cross-sectional one-way analyses of variance with Bonferroni-corrected post hoc comparisons, followed by regression models with interaction terms, main effects, and relevant covariates. Results indicated higher scores on the CPAQ for White individuals compared to Black or Hispanic individuals. Significant interactions were noted between race/ethnicity and JWB in predicting pain acceptance, after controlling for demographic and pain-related variables, such that the positive association between JWB and pain acceptance was significant for White participants only. Race/ethnicity did not show significant interactions with PI or prior racial discrimination. Findings highlight racial differences in levels of chronic pain acceptance, an adaptive pain coping response, and a stronger JWB appears to have a positive impact on pain acceptance for White individuals only. Results further confirm that members of disadvantaged racial groups may be more susceptible to poorer pain adjustment, which is the result of complex, multi-level factors. PERSPECTIVE: This study identifies racial differences in levels of pain acceptance, an adaptive psychological response to chronic pain, such that White individuals with chronic low back pain demonstrate higher levels of pain acceptance. The article further explores the impacts of intrapersonal and sociocultural variables on racial differences in pain acceptance.

The Role of Psychological Factors in Chronic Pain Treatment Outcomes in the Military

PURPOSE

Chronic pain treatment in the military includes complementary and integrative health (CIH) therapies that may affect psychological factors such as pain catastrophizing, chronic pain acceptance, pain self-efficacy, and patient activation. The unique roles that psychosocial factors play in how CIH approaches reduce pain are not clear. This study examined if a holistic pain management program improved pain outcomes through psychological mediators in service members with chronic pain.

DESIGN

Secondary analysis of a clinical trial.

METHODS

Active-duty service members (n = 210) were randomly assigned to a 3-week course of standard rehabilitative care or standard rehabilitative care combined with CIH therapies. Both treatments were followed by a 3-week functional restoration program. Study measures were completed pre- and post-treatment using the Military Health System's Pain Assessment Screening Tool and Outcomes Registry. Mediation analyses tested the indirect effects of the change in psychological factors before functional restoration on the change in pain impact (e.g., pain intensity, pain interference, functional status) after functional restoration.

RESULTS

All psychological factors except for chronic pain acceptance were related to improved pain impact (p<.05). Furthermore, a change in psychological factors prior to functional restoration was related to the change in pain impact after functional restoration. However, the addition of CIH therapies to standard rehabilitative care did not result in changes in pain outcomes mediated by the psychological factors.

CONCLUSIONS

Although psychological factors were related to pain outcomes, the effect of CIH therapies on chronic pain did not occur via a change in the four psychological factors.

The Outcome of Total Knee Arthroplasty for Patients with Psychiatric Disorders: A Single-Center Retrospective Study

Background and Objectives: For some years, psychiatric illness has been a major factor in evaluating the results of total knee arthroplasty. As with other patient-related items, patients diagnosed with mental illness have higher costs of medical treatment, longer recovery, and longer hospital stays. The aim of this paper is to evaluate the role of mental diseases on the surgical outcome compared with the normal population. Materials and Methods: At our hospital, we undertook a retrospective study between June 2020 and January 2022. The experimental group consisted of patients with mental diseases including schizophrenia, bipolar disease, depression, substance uses, or other psychiatric disorders. The control group consisted of patients who underwent total knee arthroplasty and did not have a mental disease. Postoperative complications and length of stay were also recorded during the study. We used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS) as outcome measures. Results: Between June 2020 and January 2022, a total of 634 patients underwent total knee arthroplasty in our clinic, of which 239 had a mental disease. The majority of patients were female (61%), and the average length of stay was significantly longer for patients with mental illness (6.8 vs. 2.8 days). Preoperative WOMAC and KS function scores demonstrated statistically significant differences between groups (67.83 ± 17.8 vs. 62.75 ± 15.7 and 29.31 ± 19.8 vs. 34.98 ± 21.3). KS knee score did not show any significant differences preoperatively. All postoperative functional scores showed significantly better results for the control group compared to the mental illness group. Conclusions: Mental illness appears to be linked with lower TKA scores before and after the surgical procedure.

Low back pain: biopsychosocial aspects of chronic and acute pain

Abstract: Chronic low back pain is a highly prevalent pathology, which has unclear associations with psychosocial aspects. This study investigated differences between patients with chronic low back pain (n = 25) and acute low back pain (n = 20) and verified the effect of the variables assessed on the pain mean. The design was cross-sectional, and the instruments applied were: sociodemographic interviews, Brief Pain Inventory, Beck Depression Inventory II, Hamilton Anxiety Rating Scale, Personality Factor Battery, Social Support Scale and Pain Catastrophizing Scale. The chronic pain group had significantly higher means of pain intensity, anxiety and catastrophic thoughts. In the regression analysis, the factor Depression of the Personality Factor Battery and belonging to the chronic pain group were found as predictors of the mean pain in the sample studied. It is understood that psychological factors are associated with the pain condition and require further investigation.

Web- and Mindfulness-Based Intervention to Prevent Chronic Pain After Cardiac Surgery: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Cardiac surgery is a frequently performed procedure. However, pain after cardiac surgery may become chronic (lasting >3 months) in adults. Once discharged from the hospital, patients are at greater risk of developing chronic postsurgical pain (CPSP) and of prolonged opioid use, as they need to self-manage their pain. Psychological risk and protective factors such as pain-related catastrophic thoughts and pain acceptance determine their ability to cope and their use of opioids, which is crucial for self-management of pain. Studies on mindfulness-based cognitive therapy (MBCT) have multiplied their potential effects on pain acceptance and catastrophic thoughts. However, web-based MBCT for the prevention of CPSP has not yet been examined.

OBJECTIVE

The aim of this study is to pilot test a 4-week-long web-based MBCT intervention for adults following discharge from the hospital by assessing the acceptability or feasibility of the intervention and examining preliminary effects on pain intensity, pain interference with activities and opioid use, and pain acceptance and catastrophic thoughts in the 6 months following surgery.

METHODS

A double-blinded pilot randomized controlled trial will be used to assess a web-based MBCT intervention. Patients will be selected according to the following criteria: age ≥18 years; first-time elective cardiac surgery via a median sternotomy; worst pain in the past week score ≥4/10; ability to understand and complete questionnaires in English; and ability to use an electronic device such as a smartphone, computer, or tablet. After baseline measures, 32 participants will be randomized into two groups: one receiving both the brief, 4-week-long web-based MBCT intervention and usual care (experimental group) and the other receiving only one standardized, web-based educational session with weekly reminders and usual care (attention control group). Peer-reviewed competitive funding was received from Florida State University's Council on Research & Creativity in January 2021, as well as research ethics approval from Florida State University's institutional review board.

RESULTS

Recruitment began in June 2021. Unfortunately, because of the current COVID-19 pandemic, recruitment is not progressing as expected. Recruitment strategies are constantly monitored and updated according to latest data and restrictions surrounding the pandemic.

CONCLUSIONS

This research is significant because it targets the trajectory of CPSP, a leading cause of disability and opioid misuse. This is the first study to assess MBCT for the prevention of CPSP after cardiac surgery in the recovery phase. This approach is innovative because it promotes self-management of pain through the modulation of individual factors. If successful, the intervention could be expanded to numerous populations at risk of chronic pain.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30951.

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

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.

A Network Analysis of Clinical Variables in Chronic Pain: A Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

BACKGROUND

Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective.

METHODS

In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain.

RESULTS

We found that Acceptance, Pain Interference, and Depression were key, "central," variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders.

CONCLUSIONS

This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

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.

Activity Patterns and Functioning. A Contextual-Functional Approach to Pain Catastrophizing in Women with Fibromyalgia

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.

Pain catastrophizing in daughters of women with fibromyalgia: a case-control study

Fibromyalgia is a syndrome characterized by chronic pain related to the musculoskeletal system. Patients feel incapable and show catastrophic thoughts (exaggeration of the sensations) related to painful events. This study aimed to compare catastrophic thoughts of pain between daughters of women with fibromyalgia and daughters of women without fibromyalgia, no daughter having the syndrome. It was a case-control study in which 76 women were included: 38 daughters of women diagnosed with fibromyalgia (case group), and 38 daughters of women without fibromyalgia (control group). The Brazilian versions of the Profile of Chronic Pain: Screen, the Pittsburgh Sleep Quality Index, the Pain Catastrophizing Scale, Resilience Scale, Beck Depression Inventory-II, and the State-Trait Anxiety Inventory were used. Data were tabulated and analyzed using SPSS 20.0. Continuous variables were compared between the groups using the Mann-Whitney U test or Student’s t-test for independent samples. A significant difference was considered at p < 0.05. Regarding catastrophism, the case group had higher total catastrophism compared to the control group (p = 0.025). Daughters of patients with fibromyalgia showed higher rumination and magnification levels related to pain (p = 0.028 and p = 0.007, respectively) but did not show hopelessness. This study concludes that daughters of women with fibromyalgia are more likely to have symptoms of fibromyalgia due to their visualization of the syndrome. This indicates that emotional aspects may induce changes, and additional research on an individual basis is necessary.

Does Pain Acceptance Buffer the Negative Effects of Catastrophizing on Function in Individuals With Chronic Pain?

OBJECTIVES

Pain catastrophizing and pain acceptance are psychological factors that have been shown to be associated with pain-related outcomes and predict multidisciplinary pain treatment outcomes. However, they are rarely examined in the same study. This study aimed to: (1) assess the independent roles of pain catastrophizingand pain acceptance as predictors of pain intensity, pain interference, and depression; and (2) evaluate the potential moderating role of pain acceptance on the association between pain catastrophizing and both pain and function.

MATERIALS AND METHODS

A sample of 467 adults with chronic pain completed an online survey including measures of pain intensity, pain interference, depression, pain catastrophizing, and pain acceptance.

RESULTS

Pain catastrophizing and pain acceptance were independent predictors of pain interference. Only pain catastrophizing and the activity engagement domain of pain acceptance were independent predictors of pain intensity and depression. Activity engagement moderated the association between pain catastrophizing and depression, indicating a buffering effect on the negative effects of catastrophizing on depression. Pain willingness moderated the association between pain catastrophizing and pain interference, such that endorsing low pain willingness may override any negative effects of pain catastrophizing.

DISCUSSION

The findings suggest that pain catastrophizing and pain acceptance are independently important to adjustment to chronic pain. Research is needed to determine if treatments that target both for change are more effective than treatments that target only one.

Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty?

Introduction:

The purpose of this study is to evaluate the role of major psychiatric illness on patient outcomes after total joint arthroplasty.

Methods:

Patients with a diagnosis of a major psychiatric disorder undergoing total joint arthroplasty were retrospectively matched one-to-one with a cohort without such a diagnosis. Major psychiatric disorder in the registry was identified by diagnosis of anxiety, mood, or a psychotic disorder. Primary outcome of interest included perioperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included EuroQol-5D, adverse events, length of stay, 30-day readmission, and discharge destination.

Results:

Total number of patients were 1828. The total hip arthroplasty (37.80 ± 17.91, p = 0.023) and the total knee arthroplasty psychiatric group (43.38 ± 18.41, p = 0.050) had significantly lower pre-operative WOMAC scores. At 3 months, the total hip arthroplasty (76.74 ± 16.94, p = 0.036) and total knee arthroplasty psychiatric group (71.09 ± 18.64, p < 0.01) again had significantly lower 3-month post-operative WOMAC score compared to the control groups. However, outcomes at 1 year were difficult to interpret, as patients with major psychiatric conditions had an extremely high loss to follow-up. Compared to the control groups, the total hip arthroplasty and total knee arthroplasty psychiatric group had an increased length of stay by 1.43 days (p < 0.01) and 0.77 days, respectively (p = 0.05). Similarly, the psychiatric groups were discharged directly home less often (total hip arthroplasty 86.9%, p = 0.024 and total knee arthroplasty 87.6%, p = 0.022) than the control groups.

Conclusion:

Patients with the diagnosis of a major psychiatric illness have an increased length of stay and are more likely to require a rehabilitation facility, compared to the control groups. Arguably, of utmost importance, there is a very high rate of loss to follow-up within the psychiatric groups. As such, we recommend these patients should be treated for their diagnosis prior to total joint arthroplasty. Furthermore, importance of clinical follow-up should be emphasized carefully.

Emotion regulation, pain interference and affective symptoms in children and adolescents with sickle cell disease

BACKGROUND

The ability to regulate emotion is associated with affective disorders and the experience of pain. However, little is known about emotion regulation in youth with Sickle Cell Disease (SCD), a population that regularly experiences pain and symptoms of depression and anxiety. This study examines the relationship between emotion regulation and symptoms of depression, anxiety, and pain interference in youth with SCD.

METHODS

Participants ages 8-20 at a university-based pediatric sickle cell clinic completed the Emotion Regulation Questionnaire (ERQ) and the Cognitive Emotion Regulation Questionnaire (CERQ), self-report measures assessing use of emotion regulation strategies. Participants also completed the Patient-Reported Outcomes Measurement Information System (PROMIS), measures for symptoms of anxiety, depression, and pain interference. Multiple regression models tested associations between use of emotion regulation strategies and symptoms of depression, anxiety, and pain interference.

RESULTS

Participants were 51 patients with SCD, 30 female and 21 male, with a mean age of 13.02 years (SD = 0.47, mid-max = 8-20). Use of maladaptive emotion regulation strategies was associated with increased symptoms of depression (r = .58), anxiety (r = .45) and pain interference (r = .30) in youth with SCD.

LIMITATIONS

Potential limitations of our study include small sample size, use of youth self-report measures, and participant selection contingent on the ability to attend an outpatient appointment.

CONCLUSION

Identifying maladaptive emotion regulation strategies in youth with SCD may provide clinicians with targeted pathways for improving emotional and psychological functioning.

Are Pacing Patterns Really Based on Value Goals? Exploring the Contextual Role of Pain Acceptance and Pain Catastrophizing in Women with Fibromyalgia

Pain catastrophizing and pain acceptance have been associated with functioning in fibromyalgia. In relation to activity patterns, pacing has been defined as a helpful pattern to regulate activities in the context of value-based goals, but results regarding whether it is adaptive or not are controversial. This study analyzes the moderating role of pain acceptance between pain catastrophizing and pacing in 231 women with fibromyalgia. Moderation analyses were conducted with model 1 from the PROCESS Macro version 3.4. The results showed a clear moderating effect of pain acceptance. At low levels of pain acceptance, catastrophizing and pacing patterns maintained significant and positive associations. However, at high levels of pain acceptance, pacing was independent of catastrophizing. Far from considering pacing patterns as functional or dysfunctional per se, our results suggest that women with low pain acceptance carry out pacing influenced by catastrophizing independently of their goal pursuit, while patients who accept their pain may use pacing as a regulatory mechanism according to their goals.

Catastrophising, pain self-efficacy and acceptance in patients with Burning Mouth Syndrome

BACKGROUND

Little is known about pain catastrophising, pain self-efficacy and chronic pain acceptance in burning mouth syndrome (BMS) and their effect on health-related quality of life (HRQoL) and symptoms of anxiety and depressive disorders.

OBJECTIVES

To describe pain catastrophising, pain self-efficacy and pain acceptance in BMS patients and explore associations with affective function and HRQoL.

METHODS

A cross-sectional study of 36 BMS patients (31 female) referred to an Orofacial Pain Clinic completed the Pain Catastrophizing Scale, the Pain Self-Efficacy Questionnaire and the Chronic Pain Acceptance Questionnaire-8 in addition to standardised self-reported questionnaires measuring mood and oral and generic HRQoL.

RESULTS

Pain catastrophising levels were markedly higher than (non-clinical) population norms, with 32.0% of patients reporting clinically relevant levels. Pain self-efficacy and chronic pain acceptance varied widely; 24.0% evidenced low confidence to cope with pain, and 53.8% reported low activity engagement and/or low pain willingness. Catastrophising showed moderate-to-strong associations with measures of anxiety (r = 0.63), depression (r = 0.80), and oral (r = 0.61) and generic HRQoL (rho=-0.84). Self-efficacy and acceptance were also closely related to levels of depression (r/rho=-0.83 to -0.73) and generic HRQoL (r/rho = 0.74 to 0.75). These associations were stronger than those between pain severity and affective function/HRQoL and persisted after controlling for pain severity.

CONCLUSIONS

A substantial proportion of BMS patients evidence maladaptive beliefs about personal effectiveness in managing pain, which is closely related to affective disorders and impaired HRQoL. As such, treatment approaches targeting catastrophising, pain self-efficacy and acceptance may prove beneficial in improving mood and quality of life in BMS patients.

Development and preliminary validation of the Chronic Pain Acceptance Questionnaire for Clinicians

Background and Aims Higher chronic pain acceptance is associated with lower pain and disability. Clinician beliefs are associated with patients' beliefs. This study therefore aimed to develop the Chronic Pain Acceptance Questionnaire for Clinicians (CPAQ-C) to measure clinicians' beliefs regarding the importance of levels of acceptance in patients with chronic pain, and to examine the questionnaire's psychometric properties. Methods Phase one: the CPAQ-C was adapted from the Chronic Pain Acceptance Questionnaire. Data on 162 completed questionnaires were analysed using Rasch analysis. Phase Two: the cohort completed the Healthcare Providers Pain and Impairment Relationship Scale, and the association (Pearson's correlation co-efficient) between these questionnaires examined to assist CPAQ-C validation. Twenty-four participants completed the CPAQ-C one-week later. Test re-test reliability was examined using intraclass correlation co-efficient (2,1) and standard error of measurement. Phase Three: to examine responsiveness 17 clinicians attending a workshop on Acceptance and Commitment Therapy completed the CPAQ-C before and immediately after the workshop, and six-months later. The Skillings Mack test was used to determine whether CPAQ-C scores differed across different timepoints. Results Rasch analysis supported two subscales: activity engagement and pain willingness. Five poorly functioning items were excluded. There was good correlation between the CPAQ-C and Healthcare Providers Pain and Impairment Relationship Scale (-.54). The CPAQ-C demonstrated good reliability (ICC (2,1): .81; standard error of measurement: 4.76). There was significant improvement in CPAQ-C scores following the workshop (p=<.001). Conclusions The CPAQ-C appears a valid, reliable and responsive measure of clinicians' beliefs regarding the importance of levels of acceptance in patients with chronic pain. Implications Where the CPAQ-C reveals that clinicians have low perceived levels of importance regarding acceptance in patients with chronic pain those clinicians may benefit from specific education, however, this requires further examination.

The Role of Positive Psychological Factors in the Association between Pain Intensity and Pain Interference in Individuals with Chronic Musculoskeletal Pain: A Cross-Sectional Study

This study aimed to test the cross-sectional mediating and moderating role that positive psychological factors play in the association between pain intensity and pain interference in individuals with chronic musculoskeletal pain. A descriptive cross-sectional study using mediation analyses was conducted, including 186 individuals with chronic musculoskeletal pain. We conducted cross-sectional mediation and moderation analyses to determine whether the positive psychological factors mediated or moderated the association between pain intensity and pain interference. Pain acceptance, pain self-efficacy, and optimism were all significantly and weakly related to pain interference when controlling for pain intensity. Pain self-efficacy and pain acceptance partially mediated the association between pain intensity and pain interference. On the other hand, the multiple mediation model did not show significant effects. The three positive psychological factors were not found to significantly moderate the association between pain intensity and pain interference. The findings suggest that in chronic musculoskeletal pain patients, the treatments may focus on [i] what they are capable of doing to manage the pain (i.e., pain self-efficacy) and [ii] being better able to accept the pain as pain waxes and wanes might be also particularly helpful. However, these results must be tested in longitudinal studies before drawing any causal conclusion.

"Tomorrow, I'll Be Fine": Impacts and coping mechanisms in adolescents and young adults with primary dysmenorrhoea

AIMS

To understand the experiences of adolescents and young adults with primary dysmenorrhoea through the lens of structured frameworks extant in contemporary pain literature.

DESIGN

Descriptive qualitative study.

METHODS

Thirty-nine adolescents and young adults (ages 16-24 years) with primary dysmenorrhoea participated in semi-structured in-person interviews. Transcripts of the interviews were analysed using deductive thematic analysis from November 2018 to April 2019.

RESULTS

Two overarching themes, each with subthemes, were identified. The first theme, primary dysmenorrhoea impacts the whole person, contained the following subthemes: biological, social, and psychological. The second theme, coping mechanisms of women with primary dysmenorrhoea, contained the following subthemes: primary, secondary, and passive coping.

CONCLUSION

Women experience several primary dysmenorrhoea-related impacts on their biological, social, and psychological functioning. Women employ a variety of coping mechanisms to manage their primary dysmenorrhoea pain.

IMPACT

This study emphasizes the significant effects of primary dysmenorrhoea on nearly every aspect of women's lives and contributes to an understanding of the ways women cope with this pain. The findings of this study underscore the need for continued consideration of primary dysmenorrhoea as a debilitating pain process as well as the need for additional interventions to help women manage this condition.

Beyond pain intensity and catastrophizing: The association between self-enhancing humour style and the adaptation of individuals with chronic pain

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.

A User-Centered Approach to an Evidence-Based Electronic Health Pain Management Intervention for People With Chronic Pain: Design and Development of EPIO

Background

Chronic pain conditions are complicated and challenging to live with. Electronic health (eHealth) interventions show promise in helping people cope with chronic illness, including pain. The success of these interventions depends not only on the technology and intervention content but also on the users’ acceptance and adherence. Involving all stakeholders (eg, patients, spouses, health care providers, designers, software developers, and researchers) and exploring their input and preferences in the design and development process is an important step toward developing meaningful interventions and possibly strengthening treatment outcomes.

Objective

The aim of this study was to design and develop a user-centered, evidence-based eHealth self-management intervention for people with chronic pain.

Methods

The study employed a multidisciplinary and user-centered design approach. Overall, 20 stakeholders from the project team (ie, 7 researchers, 5 editors, 7 software developers, and 1 user representative), together with 33 external stakeholders (ie, 12 health care providers, 1 health care manger, 1 eHealth research psychologist, and 17 patients with chronic pain and 2 of their spouses) participated in a user-centered development process that included workshops, intervention content development, and usability testing. Intervention content was developed and finalized based on existing evidence, stakeholder input, and user testing. Stakeholder input was examined through qualitative analyses with rapid and in-depth analysis approaches.

Results

Analyses from stakeholder input identified themes including a need for reliable, trustworthy, and evidence-based content, personalization, options for feedback, behavioral tracking, and self-assessment/registration as factors to include in the intervention. Evidence-based intervention content development resulted in one face-to-face introduction session and 9 app-based educational and exercise-based modules. Usability testing provided further insight into how to optimize the design of the intervention to the user group, identifying accessibility and a simple design to be essential.

Conclusions

The design and development process of eHealth interventions should strive to combine well-known evidence-based concepts with stakeholder input. This study, designing and developing the pain management intervention EPIO, illustrates how a stakeholder-centered design approach can provide essential input in the development of an eHealth self-management intervention for people with chronic pain.

Trial Registration

ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104

Risk and Resilience in Pediatric Pain: The Roles of Parent and Adolescent Catastrophizing and Acceptance

OBJECTIVES

Both pediatric and parent pain catastrophizing and pain acceptance are key factors associated with pediatric pain outcomes; however, the interactive effects of these factors within the parent-child dyad have yet to be tested. The aims of this study were to examine: (1) the mediating role of child catastrophizing between parent catastrophizing and child outcomes (pain interference and mobility), (2) the mediating role of child acceptance between parent acceptance and child outcomes, and (3) whether child acceptance buffers the relation between parent catastrophizing and child catastrophizing, which in turn impacts child outcomes.

MATERIALS AND METHODS

Cross-sectional data from 324 youth with chronic pain ages 10 to 17 years (mean age=14.72, [SD=2.12]; 73.1% female; 59% Caucasian) and their parents were collected. Participants completed measures assessing pediatric Patient-Reported Outcome Measurement Information System (PROMIS) domains (mobility and pain interference), pain catastrophizing, pain acceptance, and child pain intensity. Mediation was conducted via 1000-draw bootstrap-adjusted analyses in Mplus.

RESULTS

Parent pain catastrophizing was indirectly associated with child pain interference via child catastrophizing but was not associated with mobility difficulties in the mediation model. Parent pain acceptance was indirectly associated with both child pain interference and mobility via child acceptance. We did not find evidence of child acceptance-buffering parent and child pain catastrophizing.

DISCUSSION

The findings of this study highlight the need for caregiver involvement in multidisciplinary treatments to mitigate risk and enhance resilience in youth with chronic pain.

Pain acceptance in cancer patients with chronic pain in Hunan, China: A qualitative study

Objective

The purpose of this qualitative study was to describe the experiences of pain acceptance in Chinese cancer patients with chronic pain.

Methods

Twelve hospitalized cancer patients with chronic pain participated in this qualitative descriptive study from August to November 2017. In-person semi-structured interviews were conducted, recorded, transcribed, and analyzed using Colaizzi's seven-step method.

Results

The following four main themes and 15 subthemes emerged. Theme 1 (adaptation): pain is overwhelming and pain relief is a top priority, avoidance of pain-inducing factors, and resignation; theme 2 (emotional reactions to pain): feeling misunderstood, hopelessness, frustration, irritability, and concern for loved ones; theme 3 (functional limitations): daily life activities, social communication, and work; theme 4 (coping strategies): pharmacological therapies, behavioral strategies, social support strategies, and spiritual strategies.

Conclusions

This study provides a description of cancer patients' experiences related to the need for pain acceptance. These findings provide insight into the essential role of pain acceptance and underline the need to apply acceptance-based cognitive behavioral interventions as adjunctive non-pharmacological alternatives for chronic cancer pain.

A Network Analysis of the Links Between Chronic Pain Symptoms and Affective Disorder Symptoms

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 (M_age 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.

Pain Acceptance and Its Associated Factors among Cancer Patients in Mainland China: A Cross-Sectional Study

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.