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Alebouyeh F, Boutron I, Ravaud P, Tran VT. Psychometric properties and domains covered by patient-reported outcome measures used in trials assessing interventions for chronic pain. J Clin Epidemiol 2024; 170:111362. [PMID: 38615827 DOI: 10.1016/j.jclinepi.2024.111362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To identify the patient-reported outcome measures (PROMs) used in clinical trials assessing interventions for chronic pain, describe their psychometric properties, and the clinical domains they cover. STUDY DESIGN AND SETTING We identified phase 3 or 4 interventional trials: on adult participants (aged >18 years), registered in clinicaltrials.gov between January 1, 2021 and December 31, 2022, and which provided "chronic pain" as a keyword condition. We excluded diagnostic studies and phase 1 or 2 trials. In each trial, one reviewer extracted all outcomes registered and identified those captured using PROMs. For each PROM used in more than 1% of identified trials, two reviewers assessed whether it covered the six important clinical domains from the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT): pain, emotional functioning, physical functioning, participant ratings of global improvement and satisfaction with treatment, symptoms and adverse events, and participant disposition (eg, adherence to medication). Second, reviewers searched PubMed for both the initial publication and latest review reporting the psychometric properties of each PROM and assessed their content validity, structural validity, internal consistency, reliability, measurement error, hypotheses testing, criterion validity, and responsiveness using published criteria from the literature. RESULTS In total, 596 trials assessing 4843 outcomes were included in the study (median sample size 60, interquartile range 40-100). Trials evaluated behavioral (22%), device-based (21%), and drug-based (10%) interventions. Of 495 unique PROMs, 55 were used in more than 1% trials (16 were generic pain measures; 8 were pain measures for specific diseases; and 30 were measures of other symptoms or consequences of pain). About 50% PROMs had more than 50% of psychometric properties rated as sufficient. Scales often focused on a single clinical domain. Only 25% trials measured at least three clinical domains from IMMPACT. CONCLUSION Half of PROMs used in trials assessing interventions for chronic pain had sufficient psychometric properties for more than 50% of criteria assessed. Few PROMs assessed more than one important clinical domain. Only 25% of trials measured more than 3/6 clinical domains considered important by IMMPACT.
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Affiliation(s)
- Farzaneh Alebouyeh
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Isabelle Boutron
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; Université Paris Cité, CRESS, INSERM, INRAE, Paris, France
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Viet-Thi Tran
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; Université Paris Cité, CRESS, INSERM, INRAE, Paris, France.
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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.
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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
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Anderson M, McCracken LM, Scott W. An investigation of the associations between stigma, self-compassion, and pain outcomes during treatment based on Acceptance and Commitment Therapy for chronic pain. Front Psychol 2024; 15:1322723. [PMID: 38379625 PMCID: PMC10876841 DOI: 10.3389/fpsyg.2024.1322723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Stigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes. Materials and methods Five-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431). Results The results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre- and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not. Discussion The findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables.
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Affiliation(s)
- Madeleine Anderson
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Whitney Scott
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
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Amatrudo G, Kengetter J, McCrea S, Amatrudo M. Cognitive Behavioral Therapy for the Management of Episodic Migraine. Curr Pain Headache Rep 2023; 27:471-477. [PMID: 37395898 DOI: 10.1007/s11916-023-01129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW This article provides an overview of the application of CBT in the management of episodic migraine while also providing context and insight into the underlying neurophysiological mechanisms of therapeutic change. It discusses the theoretical foundations of CBT and highlights key components including education, cognitive restructuring, behavioral interventions, relaxation techniques, and lifestyle changes. RECENT FINDINGS Cognitive behavioral therapy (CBT) is an empirically based treatment that is well suited for the management of episodic migraine. Although first-line treatments of migraine are typically pharmacological, a review of empirical literature suggests growing evidence for the use of CBT as a standard non-pharmacological treatment of headache conditions. In summary, this article explores evidence supporting the efficacy of CBT in reducing the frequency, intensity, and duration of migraine attacks as well as improving the quality of life and psychological well-being of those with episodic migraine.
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Sanabria-Mazo JP, Colomer-Carbonell A, Borràs X, Castaño-Asins JR, McCracken LM, Montero-Marin J, Pérez-Aranda A, Edo S, Sanz A, Feliu-Soler A, Luciano JV. Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study). THE JOURNAL OF PAIN 2023; 24:1522-1540. [PMID: 37105508 DOI: 10.1016/j.jpain.2023.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of acceptance and commitment therapy (ACT) or behavioral activation therapy for depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at posttreatment (d = .64) and at follow-up (d = .73). BATD was only superior to TAU at follow-up (d = .66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at posttreatment (d = .45 and d = .59, respectively) and at follow-up (d = .59, in both) compared to TAU. Stress was significantly reduced at posttreatment by ACT in comparison to TAU (d = .69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant number needed to treat (NNT) values for reduction in pain interference were obtained at posttreatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at posttreatment in psychological flexibility. These findings suggest that new forms of cognitive-behavioral therapy are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. TRIAL NUMBER: NCT04140838. PERSPECTIVE: Group videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.
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Affiliation(s)
- Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Ariadna Colomer-Carbonell
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Xavier Borràs
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | | | - Jesus Montero-Marin
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Adrián Pérez-Aranda
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain; Institute of Health Research of Aragon (IIS Aragon), Miguel Servet University Hospital, Zaragoza, Spain
| | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
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Aaron RV, McGill LS, Finan PH, Wegener ST, Campbell CM, Mun CJ. Determining Profiles of Pain-Specific and General Emotion Regulation Skills and Their Relation to 12-Month Outcomes Among People With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:667-678. [PMID: 36503109 PMCID: PMC10079591 DOI: 10.1016/j.jpain.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Difficulties with pain-specific emotion regulation (ER; eg, pain catastrophizing, pain acceptance) are associated with poor pain outcomes. Less is known about how general ER relates to pain outcomes, or the extent to which pain-specific and general ER interact. In a sample (N = 1,453) of adults with chronic pain, the current study used latent profile analysis to identify subgroups of people with distinct pain-specific and general ER profiles, and determined how subgroup membership at baseline related to pain severity, pain interference, depression and anxiety symptoms at 12-month follow-up. Four groups were identified: 1) general ER difficulties only (29.6%); 2) pain-specific and general ER difficulties (26.3%); 3) skillful pain-specific and general ER (24.6%); 4) pain-specific ER difficulties only (19.4%). Controlling for auto-correlation and demographic covariates, those with pain-specific and general ER difficulties had the worst outcomes in all domains. Membership to other groups did not differentiate between pain severity or interference outcomes; those skillful in pain-specific and general ER had the lowest depression and anxiety symptoms at 12 months. General ER difficulties are common among adults with chronic pain and raise relative risk when paired with pain-specific ER difficulties. Findings offer potential directions for individualizing pain psychology treatment. PERSPECTIVE: This article shows that people with chronic pain have different sets of strengths and difficulties when it comes to regulating emotions related and/or unrelated to the experience of pain itself. Understanding an individual's unique constellation of emotion regulation skills and difficulties might help personalize the psychological treatment of pain.
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Affiliation(s)
- Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Edson College of Nursing and Health Innovation, Arizona State University, Pheonix, Arizona
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Chen JA, Anderson ML, Cherkin DC, Balderson BH, Cook AJ, Sherman KJ, Turner JA. Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:282-303. [PMID: 36180008 PMCID: PMC9898119 DOI: 10.1016/j.jpain.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with CLBP (N = 297), we examined baseline characteristics that moderated treatment effects or were associated with improvement regardless of treatment. Outcomes included 8-week function (modified Roland Disability Questionnaire), pain bothersomeness (0-10 numerical rating scale), and depression (Patient Health Questionnaire-8). There were differences in the effects of CBT versus MBSR on pain based on participant gender (P = .03) and baseline depressive symptoms (P = .01), but the only statistically significant moderator after Bonferroni correction was the nonjudging dimension of mindfulness. Scores on this measure moderated the effects of CBT versus MBSR on both function (P = .001) and pain (P = .04). Pain control beliefs (P <.001) and lower anxiety (P < .001) predicted improvement regardless of treatment. Replication of these findings is needed to guide treatment decision-making for CLBP. TRIAL REGISTRATION: The trial and analysis plan were preregistered in ClinicalTrials.gov (Identifier: NCT01467843). PERSPECTIVE: Although few potential moderators and nonspecific predictors of benefits from CBT or MBSR for CLBP were statistically significant after adjustment for multiple comparisons, these findings suggest potentially fruitful directions for confirmatory research while providing reassurance that patients could reasonably expect to benefit from either treatment.
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Affiliation(s)
- Jessica A Chen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Daniel C Cherkin
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
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Li R, Kreher DA, Gubbels AL, Palermo TM. Chronic Pelvic Pain Profiles in Women Seeking Care in a Tertiary Pelvic Pain Clinic. PAIN MEDICINE 2023; 24:207-218. [PMID: 35972368 DOI: 10.1093/pm/pnac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Female chronic pelvic pain (CPP) has multiple pain generators and significant psychosocial sequalae. Biopsychosocial-based phenotyping could help identify clinical heterogeneity that may inform tailored patient treatment. This study sought to identify distinct CPP profiles based on routinely collected clinical information and evaluate the validity of the profiles through associations with social histories and subsequent health care utilization. METHODS Women (18-77 years, n = 200) seeking care for CPP in a tertiary gynecological pelvic pain clinic between 2017 and 2020 were included. Baseline data of pain intensity, interference, catastrophizing, acceptance, overlapping pelvic pain syndromes, and co-occurring psychiatric disorders were subject to a partition around medoids clustering to identify patient profiles. Profiles were compared across social history and subsequent treatment modality, prescribed medications, and surgeries performed. RESULTS Two profiles with equal proportion were identified. Profile 1 was vulvodynia and myofascial pelvic pain-dominant characterized by lower pain burden and better psychological functioning. Profile 2 was visceral pain-dominant featuring higher pain interference and catastrophizing, lower pain acceptance, and higher psychiatric comorbidity. Patients in Profile 2 had 2-4 times higher prevalence of childhood and adulthood abuse history (all P < .001), were more likely to subsequently receive behavioral therapy (46% vs 27%, P = .005) and hormonal treatments (34% vs 21%, P = .04), and were prescribed more classes of medications for pain management (P = .045) compared to patients in Profile 1. CONCLUSIONS Treatment-seeking women with CPP could be separated into two groups distinguished by pain clusters, pain burden, pain distress and coping, and co-occurring mental health disorders.
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Affiliation(s)
- Rui Li
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Donna A Kreher
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ashley L Gubbels
- Creighton University School of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Mattsson A, Ghafouri N, Bäckryd E. The treatment lottery of chronic back pain? A case series at a multidisciplinary pain centre. Scand J Pain 2022; 23:273-283. [PMID: 36508652 DOI: 10.1515/sjpain-2022-0133] [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: 09/13/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Despite the number of people affected by chronic back pain, and the many available treatment options, even the best modalities provide limited pain reduction on a group level, often without simultaneous improvements in functioning or health-related quality of life. The objective was to provide an overview of the treatment of chronic back pain in clinical practice at a multidisciplinary pain centre, and to study patient and pain characteristics in different treatment groups. METHODS 104 chronic back pain patients (primary ICD-10-SE-diagnosis M53.0-M54.9 excluding M54.1 and M54.3), referred to the Pain and Rehabilitation Centre, University Hospital, Linköping in 2015, were studied using data from the Swedish Quality Registry for Pain Rehabilitation, self-reported medication data, and a retrospective medical record review. RESULTS The following treatment groups were identified: rehabilitation (n=21), analgesics (n=33), invasive intervention (n=14), and no treatment (n=35). Significant differences between groups were found with regards to age, sick leave, education level, persisting pain duration, punishing responses by significant other, previous invasive intervention, receiving sub-clinic, physician speciality and referring care level. CONCLUSIONS Overall, patient demographics were associated with treatment strategy to a higher degree than patient-reported outcome measures. Moreover, physician speciality and organisational factors seemed to play a role in treatment choice.
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Affiliation(s)
- Anna Mattsson
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nazdar Ghafouri
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Fang S, Ding D. Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis. Front Psychol 2022; 13:1069748. [PMID: 36562078 PMCID: PMC9767366 DOI: 10.3389/fpsyg.2022.1069748] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
The psychological flexibility model can be seen as a basis for an integrated and progressive psychological approach to chronic pain management. Some researchers suggest that psychological flexibility and inflexibility represent distinct processes and constructs. This meta-analysis is the first to provide a summary estimate of the overall effect size for the relationship between psychological (in)flexibility and common outcomes among chronic pain patients. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42021285705. Four databases were searched (PsycINFO; PubMed; Web of Science, CINAHL) along with reference lists. Thirty-six cross-sectional studies were included (7,779 participants). Meta-analyses (random effects model) indicated a significant medium negative association between psychological flexibility and pain intensity or functional impairment. The present study also indicated a significant small to medium association between psychological inflexibility and pain intensity, a nearly large association between psychological inflexibility and functional impairment as well as the quality of life, and a large association between psychological inflexibility and anxiety/depression. Due to the limited number of included studies, the relationship between risk behavior and psychological inflexibility may not be significant. Types of countries and instruments measuring psychological inflexibility may explain part of the heterogeneity. These findings may carry significant implications for chronic pain patients regarding the potential relationship between psychological inflexibility or flexibility and these outcomes. It may consequently form the basis for more robust testing of causal and manipulable relationships. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.
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Affiliation(s)
- Shuanghu Fang
- School of Educational Science, Anhui Normal University, Wuhu, China
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Slow and Steady But Not Related to HIV Stigma: Physical Activity in South Africans Living with HIV and Chronic Pain. AIDS Behav 2022; 27:1950-1961. [PMID: 36436140 DOI: 10.1007/s10461-022-03928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/28/2022]
Abstract
HIV stigma may influence physical activity in people living with HIV (PLWH) and chronic pain. We prospectively examined the relationship between stigma, activity and chronic pain in a convenience sample of PLWH initiating antiretroviral therapy in an inner-city clinic in Johannesburg, South Africa. Participants wore accelerometers to measure daily duration and intensity of activity for 2 weeks. Stigma was assessed with the Revised HIV Stigma Scale. Participants [n = 81, 89% female, age mean (SD) 42 (8)] were active for a median of 7 h daily (IQR 5.2, 9.2), but at very low intensity, equivalent to a slow walk [median (IQR): 0.39 m s-1 (0.33, 0.50)]. Duration and intensity of activity was not associated with stigma, even after controlling for age, self-assessed wealth, pain intensity and willingness to engage in physical activity (p-values > 0.05). As stigma did not associate with greater activity, drivers of sustained activity in South African PLWH remain unclear.
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Kim SY, Park SY, Mathai B, Daheim J, France C, Delgado B. Cultural dimensions of individualism and collectivism and risk of opioid misuse: A test of Social Cognitive Theory. J Clin Psychol 2022; 78:2341-2356. [PMID: 35881671 PMCID: PMC9796527 DOI: 10.1002/jclp.23425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite the critical role social and cultural contexts play in pain experience, limited theoretical and empirical attention has been devoted to the interplay between social, cognitive, cultural, and psychological factors in chronic pain management and the risk of opioid misuse. METHODS Using structural equation modeling, the present study tested the Social Cognitive Theory (SCT) of chronic pain management and risk of opioid misuse in the context of intraindividual cultural dimensions of individualism and collectivism among 316 ethnically diverse adults with chronic pain in the United States. RESULTS Social cognitive predictors account for a significant amount of variance in pain dysfunction and risk of opioid misuse in adults with chronic pain. Satisfaction with pain support was positively associated with both greater pain acceptance and greater pain self-efficacy. Individualism was found to be positively associated with satisfaction with pain support, pain self-efficacy, and pain acceptance but negatively associated with the risk of opioid misuse. Collectivism was positively associated with the risk of opioid misuse. CONCLUSIONS The study findings not only empirically support using SCT for adults with chronic pain, but also provide a more thorough conceptual framework that highlights the intracultural diversity and interplay among social, cognitive, and psychological factors that affect pain experience and the risk of opioid misuse among adults with chronic pain.
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Affiliation(s)
- Shin Ye Kim
- Department of Counseling PsychologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Sung Yong Park
- Department of PsychologyKeimyung UniversityDaeguSouth Korea
| | - Babetta Mathai
- Department of Clinical and Health PsychologyUniversity of Florida Health Science CenterGainesvilleFloridaUSA
| | - Jacob Daheim
- Department of Psychological SciencesTexas Tech UniversityLubbockTexasUSA
| | | | - Betsaida Delgado
- Department of Psychological SciencesTexas Tech UniversityLubbockTexasUSA
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Aaron RV, Mun CJ, McGill LS, Finan PH, Campbell CM. The Longitudinal Relationship Between Emotion Regulation and Pain-Related Outcomes: Results From a Large, Online Prospective Study. THE JOURNAL OF PAIN 2022; 23:981-994. [PMID: 34974172 PMCID: PMC9232929 DOI: 10.1016/j.jpain.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
People with chronic pain engage in various strategies, such as pain catastrophizing and pain acceptance, to regulate the difficult emotional aspects of living with pain. Engagement in these strategies is known to influence pain severity and pain interference. However, less research has examined the extent to which general emotion regulation, the ability to identify emotions and engage in strategies to alter emotions, relates to pain-related outcomes. The current study, a large (N = 1453) online prospective study of adults with chronic pain, employed theory-driven assessment of emotion regulation to determine the extent to which general difficulties with emotion regulation at baseline relate to pain severity and pain interference at three-month follow-up, above and beyond pain catastrophizing and pain acceptance. We conducted a series of path models, controlling for demographic covariates and baseline pain severity and pain interference. Pain catastrophizing and pain acceptance at baseline significantly predicted pain interference at three-month follow-up. However, when indices of general emotion regulation were entered into the model, the associations between pain catastrophizing and pain interference (B = .009, P = .153) were no longer statistically significant. Alexithymia emerged as a significant predictor of pain severity (B = .012, P = .032) and pain interference (B = .026, P < .001). These findings highlight the value of considering the role of general emotion regulation (particularly identifying and describing emotions), in addition to pain-specific experiences, in understanding risk for poor pain-related outcomes. PERSPECTIVE: In addition to pain catastrophizing and pain acceptance, difficulties regulating emotions in general (particularly elevated alexithymia) relates to pain outcomes three months later. These findings shed light on risk for poor pain outcomes and point to general emotion regulation as a potentially important target of chronic pain intervention.
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Affiliation(s)
- Rachel V Aaron
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, Maryland.
| | - Chung Jung Mun
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
| | - Lakeya S McGill
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, Maryland
| | - Patrick H Finan
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
| | - Claudia M Campbell
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
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Menzies RE, Sharpe L, Richmond B, Dudeney J, Todd J, Szabo M, Sesel AL, Dear B. Randomised controlled trial of cognitive behaviour therapy versus mindfulness for people with rheumatoid arthritis with and without a history of recurrent depression: study protocol and design. BMJ Open 2022; 12:e056504. [PMID: 35589354 PMCID: PMC9121498 DOI: 10.1136/bmjopen-2021-056504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Psychosocial treatments have been shown to benefit people with rheumatoid arthritis (RA) on various outcomes. Two evidence-based interventions are cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR). However, these interventions have been compared only once. Results showed that CBT outperformed MBSR on some outcomes, but MBSR was more effective for people with RA with a history of recurrent depression, with efficacy being moderated by history of depressive episodes. However, this was a post-hoc finding based on a small subsample. We aim to examine whether a history of recurrent depression will moderate the relative efficacy of these treatments when delivered online. METHODS AND ANALYSIS This study is a randomised controlled trial comparing CBT and MBSR delivered online with a waitlist control condition. History of recurrent depressive episodes will be assessed at baseline. The primary outcome will be pain interference. Secondary outcomes will include pain intensity, RA symptoms, depressive symptoms and anxiety symptoms. Outcome measures will be administered at baseline, post-treatment and at 6 months follow-up. We aim to recruit 300 participants, and an intention-to-treat analysis will be used. Linear mixed models will be used, with baseline levels of treatment outcomes as the covariate, and group and depressive status as fixed factors. The results will demonstrate whether online CBT and MBSR effectively improve outcomes among people with RA. Importantly, this trial will determine whether one intervention is more efficacious, and whether prior history of depression moderates this effect. ETHICS AND DISSEMINATION The trial has been approved by the Human Research Ethics Committee of the University of Sydney (2021/516). The findings will be subject to publication irrespective of the final results of the study, and based on the outcomes presented in this protocol. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621000997853p).
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Affiliation(s)
- Rachel E Menzies
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Bethany Richmond
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Dudeney
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jemma Todd
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy-Lee Sesel
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Blake Dear
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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15
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Schroeter AC, MacDonald DA, Scholten-Peeters GGM, Goubert L, Kendall E, Coppieters MW. Preferred self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. A modified Delphi study. PAIN MEDICINE 2022; 23:1891-1901. [DOI: 10.1093/pm/pnac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
The plethora of self-administered questionnaires to assess positive psychosocial factors complicates questionnaire selection. This study aimed to identify and reach consensus on the most suitable self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain.
Design
A three-round modified Delphi study.
Participants
Forty international experts.
Methods
In Round 1, the experts suggested questionnaires deemed appropriate to assess resilience, optimism, pain acceptance and/or social support. In Round 2, experts indicated whether they considered the suggested questionnaires to be suitable (Yes/No/Don’t know) to assess these psychosocial factors, taking into consideration content, feasibility, personal experience and the measurement properties which we provided for each questionnaire. Questionnaires that were considered suitable by the majority of experts (≥60%) were retained for Round 3. In Round 3, the suitability of each questionnaire was rated on a 0–10 Likert scale. Consensus was reached if ≥ 75% of experts rated the questionnaire ≥7.
Results
From the 67 questionnaires suggested in Round 1, one questionnaire could be recommended per domain. For resilience: Pain Resilience Scale; for optimism: Revised Version of the Life Orientation Test; for pain acceptance: 8-item and Revised Versions of the Chronic Pain Acceptance Questionnaire; for social support: Emotional Support Item Bank of the PROMIS tool. Consensus for these questionnaires was also reached in a sensitivity analysis which excluded the ratings of experts involved in the development, translation and/or validation of relevant questionnaires.
Conclusion
We advocate the use of these recommended questionnaires so data can be compared and pooled more easily.
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Affiliation(s)
- Andrea C Schroeter
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | - David A MacDonald
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | | | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
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Ding D, Zheng M. Associations Between Six Core Processes of Psychological Flexibility and Functioning for Chronic Pain Patients: A Three-Level Meta-Analysis. Front Psychiatry 2022; 13:893150. [PMID: 35898622 PMCID: PMC9309299 DOI: 10.3389/fpsyt.2022.893150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.
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Affiliation(s)
- Dongyan Ding
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Mengna Zheng
- School of Educational Science, Anhui Normal University, Wuhu, China
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17
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Psychological Flexibility, Pain Characteristics and Risk of Opioid Misuse in Noncancerous Chronic Pain Patients. J Clin Psychol Med Settings 2021; 28:405-417. [PMID: 32519037 DOI: 10.1007/s10880-020-09729-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Chronic pain has an estimated annual prevalence rate between 10 and 35%. In the US, first-line treatment for chronic pain is often opioids. OBJECTIVE To our knowledge, this is the first study exploring psychological flexibility and its association with pain severity, pain interference and risk of opioid misuse in chronic pain patients. METHODS Data were collected at two outpatient pain clinics in the northeastern United States. Adults (N = 99) completed a cross-sectional survey with validated measures. Pain severity and pain interference were hypothesized to uniquely predict the risk of opioid misuse. Pain severity was hypothesized to predict pain interference. Finally, psychological flexibility was hypothesized as an indirect effect in these relationships. RESULTS Main findings suggest that pain severity predicts risk of opioid misuse, mediated by psychological flexibly. Pain interference also predicts risk of opioid misuse, mediated by psychological flexibility. Finally, results suggest pain severity predicts pain interference, mediated by psychological flexibility. DISCUSSION Implications of findings are discussed in terms of future psychological and medical assessments and interventions for chronic pain patients seeking prescription opioids.
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18
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Henrik G, Patrik M, Anders H, Ulf J, Marcelo RF, Åsa R. Tapering of prescribed opioids in patients with long-term non-malignant pain (TOPIO)-efficacy and effects on pain, pain cognitions, and quality of life: a study protocol for a randomized controlled clinical trial with a 12-month follow-up. Trials 2021; 22:503. [PMID: 34321058 PMCID: PMC8318331 DOI: 10.1186/s13063-021-05449-5] [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: 09/04/2020] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Opioids are still widely prescribed to long-term pain patients although they are no longer recommended for long-term treatments due to poor evidence for long-term efficacy, risks of serious side effects, and the possibility of inducing opioid hyperalgesia. In a Cochrane study from 2017, the authors identified an urgent need for more randomized controlled trials investigating the efficiency and effects of opioid tapering. The study aimed to assess (1) the efficiency of a structured intervention in causing stable reductions of opioid consumption in a population with long-term non-malignant pain and (2) effects on pain, pain cognitions, physical and mental health, quality of life, and functioning in response to opioid tapering. Methods The study is a randomized controlled trial. The sample size was set to a total of 140 individuals after estimation of power and dropout. Participants will be recruited from a population with long-term non-malignant pain who will be randomly allocated to (1) the start of tapering immediately or (2) the control group who return to usual care and will commence tapering of opioids 4 months later. A 12-month follow-up is included. When all follow-ups are closed, data from the Swedish drug register of the National Board of Health and Welfare will be collected and individual mean daily opioid dose in morphine equivalents will be calculated at three time points: baseline, 4 months, and 12 months after the start of the intervention. At the same time points, participants fill out the following questionnaires: Numeric Pain Rating Scale (NPRS), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Hospital Anxiety and Depression Scale (HADS), and RAND-36. At baseline and follow-up, a clinical assessment of opioid use disorder is performed. Discussion A better understanding of the efficiency and effects of opioid tapering could possibly facilitate attempts to taper opioid treatments, which might prove beneficial for both the individual and society. Trial registration ClinicalTrials.gov NCT03485430. Retrospectively registered on 26 March 2018, first release date. “Tapering of Long-term Opioid Therapy in Chronic Pain Population. RCT with 12 Months Follow up (TOPIO).” First patient in trial 22 March 2018.
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Affiliation(s)
- Grelz Henrik
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 221 85, Lund, Sweden. .,Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden.
| | - Midlöv Patrik
- Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
| | - Håkansson Anders
- Department of Clinical Sciences Lund, Faculty of Medicine, Psychiatry, Lund University, Baravägen 1, 221 00, Lund, Sweden
| | - Jakobsson Ulf
- Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
| | - Rivano Fischer Marcelo
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 221 85, Lund, Sweden.,Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
| | - Ringqvist Åsa
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 221 85, Lund, Sweden.,Center for Primary Health Care Research, Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 202 13, Malmö, Sweden
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19
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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.
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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
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Sahar K, Thomas SA, Clarke SP. Adjustment to fibromyalgia: The role of domain‐specific self‐efficacy and acceptance. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Karan Sahar
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK,
| | - Shirley A. Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK,
| | - Simon P. Clarke
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK,
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK,
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21
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Sanabria-Mazo JP, Forero CG, Cristobal-Narváez P, Suso-Ribera C, García-Palacios A, Colomer-Carbonell A, Pérez-Aranda A, Andrés-Rodríguez L, McCracken LM, D'Amico F, Estivill-Rodríguez P, Carreras-Marcos B, Montes-Pérez A, Comps-Vicente O, Esteve M, Grasa M, Rosa A, Cuesta-Vargas AI, Maes M, Borràs X, Edo S, Sanz A, Feliu-Soler A, Castaño-Asins JR, Luciano JV. Efficacy, cost-utility and physiological effects of Acceptance and Commitment Therapy (ACT) and Behavioural Activation Treatment for Depression (BATD) in patients with chronic low back pain and depression: study protocol of a randomised, controlled trial including mobile-technology-based ecological momentary assessment (IMPACT study). BMJ Open 2020; 10:e038107. [PMID: 32709656 PMCID: PMC7380881 DOI: 10.1136/bmjopen-2020-038107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The IMPACT study focuses on chronic low back pain (CLBP) and depression symptoms, a prevalent and complex problem that represents a challenge for health professionals. Acceptance and Commitment Therapy (ACT) and Brief Behavioural Activation Treatment for Depression (BATD) are effective treatments for patients with persistent pain and depression, respectively. The objectives of this 12 month, multicentre, randomised, controlled trial (RCT) are (i) to examine the efficacy and cost-utility of adding a group-based form of ACT or BATD to treatment-as-usual (TAU) for patients with CLBP and moderate to severe levels of depressive symptoms; (ii) identify pre-post differences in levels of some physiological variables and (iii) analyse the role of polymorphisms in the FKBP5 gene, psychological process measures and physiological variables as mediators or moderators of long-term clinical changes. METHODS AND ANALYSIS Participants will be 225 patients with CLBP and moderate to severe depression symptoms recruited at Parc Sanitari Sant Joan de Déu (St. Boi de Llobregat, Spain) and Hospital del Mar (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs TAU+ACT versus TAU+BATD. A comprehensive assessment to collect clinical variables and costs will be conducted pretreatment, post-treatment and at 12 months follow-up, being pain interference the primary outcome measure. The following physiological variables will be considered at pretreatment and post-treatment assessments in 50% of the sample: immune-inflammatory markers, hair cortisol and cortisone, serum cortisol, corticosteroid-binding globulin and vitamin D. Polymorphisms in the FKBP5 gene (rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916) will be analysed at baseline assessment. Moreover, we will include mobile-technology-based ecological momentary assessment, through the Pain Monitor app, to track ongoing clinical status during ACT and BATD treatments. Linear mixed-effects models using restricted maximum likelihood, and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu and Hospital del Mar. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. TRIAL REGISTRATION NUMBER NCT04140838.
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Affiliation(s)
- Juan P Sanabria-Mazo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medicine, International University of Catalunya, Barcelona, Spain
- Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Catalunya, Spain
| | - Carlos G Forero
- Department of Medicine, International University of Catalunya, Barcelona, Spain
| | - Paula Cristobal-Narváez
- Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Catalunya, Spain
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Ariadna Colomer-Carbonell
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Catalunya, Spain
| | - Adrián Pérez-Aranda
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Consorci Parc de Salut MAR de Barcelona, Barcelona, Catalunya, Spain
| | - Laura Andrés-Rodríguez
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Francesco D'Amico
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | | | | | | | - Montserrat Esteve
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
- Department of Biochemistry and Molecular Biomedicine, University of Barcelona, Barcelona, Spain
- Institute of Biomedicine (IBUB), University of Barcelona, Barcelona, Spain
| | - Mar Grasa
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
- Department of Biochemistry and Molecular Biomedicine, University of Barcelona, Barcelona, Spain
- Institute of Biomedicine (IBUB), University of Barcelona, Barcelona, Spain
| | - Araceli Rosa
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- Department of Evolutionary Biology, Ecology and Environmental Sciences, University of Barcelona, Barcelona, Spain
| | - Antonio I Cuesta-Vargas
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Physiotherapy, University of Malaga & Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Xavier Borràs
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Silvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Albert Feliu-Soler
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Catalunya, Spain
| | | | - Juan V Luciano
- Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Catalunya, Spain
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March MK, Harmer A, Godfrey E, Venkatesh S, Thomas B, Dennis S. The KOMPACT-P study: Knee Osteoarthritis Management with Physiotherapy informed by Acceptance and Commitment Therapy-Pilot study protocol. BMJ Open 2020; 10:e032675. [PMID: 32499254 PMCID: PMC7279646 DOI: 10.1136/bmjopen-2019-032675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Incidence of total knee arthroplasty (TKA) is projected to rise 276% in 2030, and psychological distress affects up to 42% of people with knee osteoarthritis undergoing TKA, with demonstrated detrimental effects on postoperative outcomes. Few studies have assessed psychological treatment in people awaiting TKA, and these have been psychologist-delivered treatments. No evidence exists regarding psychologically-informed interventions delivered by health professionals currently embedded in TKA clinical pathways. The primary aim of this pilot study is to explore the safety, acceptability and feasibility of the Knee Osteoarthritis Management with Physiotherapy informed by Acceptance and Commitment Therapy (KOMPACT) approach in people awaiting TKA. METHODS AND ANALYSIS 51 community-dwelling adults scheduled for a primary TKA at two hospitals will be recruited to this pilot, mixed-methods, prospective randomised controlled trial with assessor blinding. Participants will be randomised in a 1:2 ratio to either usual care (education class) or usual care plus KOMPACT (2 hours 20 min of preoperative physiotherapy informed by Acceptance and Commitment Therapy). Our primary outcome measures are safety (length of stay, complications and psychological health after KOMPACT), acceptability (treatment credibility and qualitative data) and feasibility (recruitment, retention and intervention fidelity) of the KOMPACT approach. Secondary outcomes include health service outcomes, patient-reported physical and psychological outcomes, and physical performance measures. Quantitative data collection was conducted at baseline, 1-2 weeks before TKA, 6 weeks after TKA and 6 months after TKA. Qualitative data collection is 1-2 weeks before TKA. Data analysis will take a quantitative-led approach with triangulation after thematic analysis of the qualitative data. ETHICS AND DISSEMINATION This study has full ethics approval (HREC/18/WMEAD/440). Results from this study will be published in peer-reviewed journals and presented at local and international conferences. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry (ACTRN12618001867280p).
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Affiliation(s)
- Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alison Harmer
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Emma Godfrey
- Department of Health Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Shruti Venkatesh
- Renal Supportive Care, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Bijoy Thomas
- Orthopaedic Department, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Sarah Dennis
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
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23
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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.
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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
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24
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O’Beaglaoich C, McCutcheon J, Conway PF, Hanafin J, Morrison TG. Adolescent Suicide Ideation, Depression and Self-Esteem: Relationships to a New Measure of Gender Role Conflict. Front Psychol 2020; 11:111. [PMID: 32153450 PMCID: PMC7047665 DOI: 10.3389/fpsyg.2020.00111] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 01/15/2020] [Indexed: 01/26/2023] Open
Abstract
Among 15-24 year olds in Ireland, completed suicide was responsible for 4.1 times more male deaths than female deaths in 2014 (World Health Organization [WHO], 2017). Few international research studies have investigated the relationship between masculinity [as assessed by a measure of gender role conflict (GRC)] and suicide ideation, and none have done so with Irish adolescents. Therefore, the purpose of the current study was to investigate the relationships between a new measure of GRC developed specifically for use with Irish adolescents (I-GRCS-A; O'Beaglaoich et al., 2016), and depression, self-esteem, and negative/protective suicide ideation. A sample of 176 adolescent boys (M = 16.9, SD = 0.94) from a non-clinical population participated in the study. Regression analyses and tests of mediation revealed that depression significantly mediated the relationship between GRC and negative suicide ideation, whilst self-esteem and depression significantly mediated the relationship between GRC and positive suicide ideation. Implications and limitations of the current study are outlined and directions for future research are discussed.
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Affiliation(s)
- Cormac O’Beaglaoich
- School of Education, University of Limerick, Limerick, Ireland
- National Institute for Studies in Education, Limerick, Ireland
| | - Jessica McCutcheon
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Paul F. Conway
- School of Education, University of Limerick, Limerick, Ireland
- National Institute for Studies in Education, Limerick, Ireland
| | - Joan Hanafin
- National Institute for Studies in Education, Limerick, Ireland
- Inclusion in Education and Society Research Group, School of Education, Trinity College Dublin, Dublin, Ireland
| | - Todd G. Morrison
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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25
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McCurry SM, Von Korff M, Morin CM, Cunningham A, Pike KC, Thakral M, Wellman R, Yeung K, Zhu W, Vitiello MV. Telephone interventions for co-morbid insomnia and osteoarthritis pain: The OsteoArthritis and Therapy for Sleep (OATS) randomized trial design. Contemp Clin Trials 2019; 87:105851. [PMID: 31614214 PMCID: PMC6886712 DOI: 10.1016/j.cct.2019.105851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 12/25/2022]
Abstract
The OsteoArthritis and Therapy for Sleep (OATS) study is a population-based randomized controlled trial of cognitive behavioral therapy for insomnia (CBTI) with four innovative methodological aims. These are to: (1) Enroll representative participants across Washington state, including those from medically underserved communities; (2) Enroll persons with persistent insomnia and chronic osteoarthritis (OA) pain; (3) Test a scalable CBT-I intervention; and (4) Evaluate patient-reported outcomes (insomnia, pain severity, fatigue, depression) and cost-effectiveness over one year. This paper describes progress towards achieving these aims. The target population was persons age 60+ who had received OA care within the Kaiser Permanente Washington (KPW) health care system. We employed a two-phase screening via mail survey and telephone follow-up, with a 3-week interval between screens to exclude persons with spontaneous improvement in sleep or pain symptoms. Participants were randomized to a 6-session telephone-delivered CBT-I intervention or a 6-session telephone education only control condition (EOC). Blinded outcome assessments (completed online or on mailed paper forms) included primary and secondary sleep and pain outcome measures and quality of life measures. We obtained healthcare utilization from administrative claims data. Intent to treat analyses, including all participants randomized when they scheduled the first telephone session, will be conducted to compare CBT-I and EOC outcomes. The trial will be the largest experimental evaluation of telephone CBT-I to date, and the first to evaluate its cost-effectiveness. Trial registration: ClinicalTrials.gov identifier: NCT02946957.
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Affiliation(s)
- Susan M McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States of America.
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Charles M Morin
- Department of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Amy Cunningham
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States of America
| | - Kenneth C Pike
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States of America
| | - Manu Thakral
- Department of Nursing, University of Massachusetts Boston, Boston, MA, United States of America
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America
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26
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Cutoff scores for the 8-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8) to identify different profiles of pain acceptance patterns, levels of function and behavioral flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Sánchez-Rodríguez E, de la Vega R, Racine M, Roy R, Jensen MP, Miró J. Support for the Spanish version of the CPAQ-8 as a measure of chronic pain acceptance. J Eval Clin Pract 2019; 25:881-888. [PMID: 30592117 DOI: 10.1111/jep.13092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 12/30/2022]
Abstract
AIM AND OBJECTIVE To provide evidence regarding the psychometric properties of the Spanish eight-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8). METHOD Three hundred adults with chronic pain completed measures of pain acceptance, committed action, fear of movement, anxiety, depression, and health-related quality of life. A confirmatory factor analysis (CFA) of the CPAQ-8 was performed. Reliability and validity were also evaluated. RESULTS The CFA confirmed a two-factor structure. The CPAQ-8 Total and subscale scores showed acceptable-to-good internal consistency. Furthermore, the Total and the Activity Engagement scale scores showed moderate associations with Committed Action scores, supporting construct validity. Both the Total and the two subscale scores showed good criterion validity. CONCLUSION The findings provide further support for the reliability and validity of the Spanish version of the CPAQ-8 Total and subscale scores.
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Affiliation(s)
- Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Rocío de la Vega
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mélanie Racine
- Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Rubén Roy
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
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28
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Burke D, Lennon O, Blake C, Nolan M, Barry S, Smith E, Maye F, Lynch J, O'Connor L, Maume L, Cheyne S, Ní Ghiollain S, Fullen BM. An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial. Eur J Pain 2019; 23:1264-1282. [PMID: 31002442 DOI: 10.1002/ejp.1402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT-PMPs) have a growing evidence base to support their uptake clinically. The development of internet-delivered treatment options may overcome barriers to the access and uptake of centre-based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep. METHODS Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT-PMP delivered once weekly. A blinded assessor determined changes in self-reported outcome measures post-intervention and at 3 months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p < 0.05. RESULTS The recruitment rate was 32% (intervention n = 35, control n = 34), and the drop-out rate at 3 months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ2 = 8.22, p = 0.016), worst pain (χ2 = 11.20, p = 0.004), and Brief Pain Inventory (interference) (χ2 = 6.924, p = 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38-0.84). At 3-month follow-up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05). CONCLUSIONS This study demonstrates the potential of an internet-delivered SCI specific CBT-PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.
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Affiliation(s)
- Dearbhla Burke
- UCD School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin 4, Ireland
| | - Olive Lennon
- UCD School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin 4, Ireland
| | - Catherine Blake
- UCD School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin 4, Ireland.,UCD Centre for Translational Pain Research, University College Dublin, Dublin 4, Ireland
| | - Maeve Nolan
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Sorcha Barry
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Eimear Smith
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Fiona Maye
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - John Lynch
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Lorna O'Connor
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Liz Maume
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Sheena Cheyne
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Sadb Ní Ghiollain
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Brona M Fullen
- UCD School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin 4, Ireland.,UCD Centre for Translational Pain Research, University College Dublin, Dublin 4, Ireland
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29
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Slattery BW, O'Connor LL, Haugh S, Barrett K, Francis K, Dwyer CP, O'Higgins S, Caes L, Egan J, McGuire BE. Investigating the effectiveness of an online acceptance and commitment therapy (ACT) intervention versus a waiting list control condition on pain interference and quality of life in adults with chronic pain and multimorbidity: protocol for a randomised controlled trial. BMJ Open 2019; 9:e012671. [PMID: 31076466 PMCID: PMC6527999 DOI: 10.1136/bmjopen-2016-012671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Multimorbidity refers to the presence of two or more chronic health conditions within one person, where no one condition is primary. Research suggests that multimorbidity is highly correlated with chronic pain, which is pain lasting longer than 3 months. Psychotherapeutic interventions for people living with chronic illness have resulted in reduced symptom reporting and improved psychological well-being. There is a dearth of research, however, using online psychotherapy for people living with multimorbidity where chronic pain is a central condition. This study will compare the effectiveness of an online acceptance and commitment therapy (ACT) intervention with a waiting list control condition in terms of improving health-related quality of life (HRQoL) and reducing levels of pain interference in people with chronic pain and at least one other condition. METHODS AND ANALYSIS 192 adult participants with non-malignant pain that persists for at least 3 months and at least one other medically diagnosed condition will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. A waiting list group will be offered the ACT intervention after the 3-month follow-up period. HRQoL and pain interference will act as the primary outcomes. Data will be analysed using a linear mixed model and adjusted to account for demographic and clinical variables as necessary. A Study Within a Trial will be incorporated to examine the effect on recruitment and retention of showing participants an animated educational video. ETHICS AND DISSEMINATION Ethical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via peer reviewed journal articles and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN22343024.
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Affiliation(s)
- Brian W Slattery
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
- School of Nursing and Human Sciences, Dublin City University, Dublin, Dublin, Ireland
| | - Laura L O'Connor
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Stephanie Haugh
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Katie Barrett
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Kady Francis
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Christopher P Dwyer
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Siobhan O'Higgins
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Line Caes
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Jonathan Egan
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
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30
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Sedighimornani N, Rimes K, Verplanken B, Gauntlett-Gilbert J. Acceptance of shame and embarrassment: Scale development and initial findings in a clinical sample. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Carvalho SA, Gillanders D, Palmeira L, Pinto-Gouveia J, Castilho P. Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance. J Clin Psychol 2018; 74:2094-2106. [PMID: 30101973 DOI: 10.1002/jclp.22689] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/05/2018] [Accepted: 07/13/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE(S) The aim of this study was to test a theory driven model in which pain acceptance (both pain willingness [PW] and activity engagement [AE]) mediates the relationships of mindfulness and selfcompassion with depressive symptoms, while controlling for pain intensity. METHODS A path analysis was conducted using AMOS software to test a meditational model in a sample of women with chronic musculoskeletal pain (N = 231). RESULTS Participants with higher levels of mindful awareness and selfcompassion presented lower levels of pain intensity and depressive symptoms, and higher levels of AE. PW did not significantly correlate with any variable in study. The mediation analysis showed that AE mediated the relationship between selfcompassion and depressive symptoms, independently from pain intensity. CONCLUSIONS These findings seem to corroborate the hypothesis that selfcompassion is rooted in a motivational system, as it seems to correlate with less depressive symptoms through increasing the engagement with valued actions despite experiencing pain.
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Affiliation(s)
- Sérgio A Carvalho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - David Gillanders
- Department of Clinical Psychology, School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Lara Palmeira
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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32
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A Multivariate Validity Analysis of the Pain-related Cognitive Processes Questionnaire. Clin J Pain 2018; 34:723-731. [DOI: 10.1097/ajp.0000000000000587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain 2017; 157:2434-2444. [PMID: 27257859 DOI: 10.1097/j.pain.0000000000000635] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cognitive behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with chronic low back pain (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (nonreactivity, nonjudging, and acting with awareness; all P values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P values <0.05) measures. Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the subsample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain.
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Harrison AM, McCracken LM, Jones K, Norton S, Moss-Morris R. Using mixed methods case-series evaluation in the development of a guided self-management hybrid CBT and ACT intervention for multiple sclerosis pain. Disabil Rehabil 2017; 39:1785-1798. [PMID: 27557625 DOI: 10.1080/09638288.2016.1209580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Two-thirds of the people with multiple sclerosis (pwMS) experience pain. Medications provide minimal relief, and current non-pharmacological interventions lack a clear conceptualization of MS pain. This study explored the potential efficacy of a telephone-supported hybrid cognitive behavior therapy and acceptance and commitment therapy self-management intervention for pwMS based on an empirically supported model of MS pain using a replicated single-case series design. METHODS Seven pwMS with varied demographic and disease characteristics completed the 8-week home-based program alongside 3 hours of telephone support. Online questionnaires were completed every four days for 16 weeks (4-weeks baseline, 8-weeks treatment, 4-weeks follow-up). The primary outcomes were pain severity and pain interference. Psychological process variables drawn from the MS pain model were also completed, and post-treatment qualitative interviews conducted. RESULTS Simulation modeling analysis (SMA) showed three patients had large improvements in pain outcomes, two showed no change and two worsened. Five participants showed significant change on various psychological process variables. Change in pain catastrophizing was the most consistent finding. CONCLUSIONS The findings suggest a self-management program for MS pain with minimal therapy support may be effective for some pwMS, but not those with more complex comorbidities. The participants suggested web-based delivery may simplify the approach, and therapist telephone contact was highly valued. Implications for Rehabilitation This case series suggests a hybrid CBT/ACT self-management workbook program for MS pain improves severity and impact of pain in some pwMS. Pain-related catastrophizing reduced in most pwMS, whilst change in other ACT and CBT process variables varied across the individuals. PwMS feedback suggests a tailored web-based delivery of the program with therapist telephone support may be optimal. PwMS with serious co-morbid depression and very advanced disease may not respond well to this self-management approach.
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Affiliation(s)
- Anthony M Harrison
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Lance M McCracken
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Katherine Jones
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Sam Norton
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Rona Moss-Morris
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
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Gagnon J, Dionne F, Balbinotti M, Monestès JL. Dimensionality and validity of the Committed Action Questionnaire (CAQ-8) in a chronic pain and university student population. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yu L, Norton S, McCracken LM. Change in “Self-as-Context” (“Perspective-Taking”) Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning. THE JOURNAL OF PAIN 2017; 18:664-672. [DOI: 10.1016/j.jpain.2017.01.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 12/01/2022]
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Bakhshaie J, Kauffman BY, Viana AG, Garza M, Ochoa-Perez M, Lemaire C, Bogiaizian D, Robles Z, Zvolensky MJ. Synergistic effects of pain intensity and experiential avoidance in relation to anxiety symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. J Anxiety Disord 2017; 48:54-62. [PMID: 27667748 DOI: 10.1016/j.janxdis.2016.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022]
Abstract
Latinos are subject to numerous health inequalities, including mental health disparity for anxiety and its disorders. In fact, there is strikingly little understanding of transdiagnostic risk factors for the onset and development of anxiety symptoms and disorders among Latinos. To build knowledge in this domain, the present investigation examined the interactive effects of experiential avoidance and pain intensity in relation to anxious arousal, social anxiety, and anxiety disorders among 361 Latino adults with annual incomes of less than $30,000 (87.5% female; Mage=38.8, SD=11.4, and 98.5% used Spanish as their first language) who attended a community-based primary healthcare clinic. As hypothesized, the interaction between experiential avoidance and pain intensity was significantly related to anxious arousal, social anxiety, and a number of anxiety disorders over and above the effects of other factors. The form of the significant interactions indicated that participants reporting co-occurring higher levels of experiential avoidance and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between experiential avoidance and pain intensity in regard to a relatively wide array of anxiety problems among Latinos in a primary care medical setting.
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Affiliation(s)
- Jafar Bakhshaie
- Department of Psychology, University of Houston, United States.
| | | | - Andres G Viana
- Department of Psychology, University of Houston, United States
| | | | | | | | - Daniel Bogiaizian
- Psychotherapeutic Area of "Asociación Ayuda", Anxiety Disorders Clinic, United States
| | - Zuzuky Robles
- Department of Psychology, University of Houston, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, United States; Department of Behavioral Sciences, University of Texas, MD Anderson Cancer Center, United States
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Rovner GS, Sunnerhagen KS, Björkdahl A, Gerdle B, Börsbo B, Johansson F, Gillanders D. Chronic pain and sex-differences; women accept and move, while men feel blue. PLoS One 2017; 12:e0175737. [PMID: 28441403 PMCID: PMC5404887 DOI: 10.1371/journal.pone.0175737] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation. Method 1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p ≤.01. Results Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level. Conclusion Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.
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Affiliation(s)
- Graciela S. Rovner
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Katharina S. Sunnerhagen
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- * E-mail:
| | - Ann Björkdahl
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- Ersta Skondal University College, Campus Bracke, Gothenburg, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linkoping University, Linkoping, SE-581 85 Linköping, Sweden
| | - Björn Börsbo
- Division of Community Medicine, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
- Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jonkoping, Sweden
| | | | - David Gillanders
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
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Alschuler KN, Kratz AL, Ehde DM. Resilience and vulnerability in individuals with chronic pain and physical disability. Rehabil Psychol 2017; 61:7-18. [PMID: 26881303 DOI: 10.1037/rep0000055] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the independent contributions of vulnerability and resilience factors to pain interference, self-efficacy for managing pain, global mental health, and global physical health. RESEARCH METHOD/DESIGN Secondary analysis of baseline data from individuals with a spinal cord injury (n = 73), amputation (n = 33), or multiple sclerosis (n = 82) and chronic pain who participated in a randomized controlled trial comparing 2 chronic pain interventions. Participants completed a comprehensive battery of pain-related outcomes that assessed for both psychosocial assets and maladaptive cognitions and behaviors. RESULTS Results suggested that vulnerability and resilience factors together account for a considerable amount of variance in the physical outcomes, but that neither set of factors was able to make a substantial contribution above and beyond the other. In contrast, for mental health related outcomes, results indicated that resilience factors did make a meaningful contribution above and beyond vulnerability factors, suggesting the important contribution of resilience factors to the psychological experience of chronic pain. CONCLUSIONS The present study suggested a valuable contribution of both resilience and vulnerability factors to pain outcomes, with the additional caveat that resilience factors uniquely impact specific outcomes-particularly those that are more psychosocially focused-above and beyond vulnerability factors. Taken together, this highlights the importance of considering resilience factors in addition to vulnerability factors for individuals with chronic pain. Additional research is needed to explore other factors that could be considered representative of the resilience construct and more attention should be focused on evaluating the effects of interventions that seek to build an individual's assets.
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Affiliation(s)
- Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine
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Differing Psychologically Derived Clusters in People With Chronic Low Back Pain are Associated With Different Multidimensional Profiles. Clin J Pain 2016; 32:1015-1027. [DOI: 10.1097/ajp.0000000000000363] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Changes in Acceptance in a Low-Intensity, Group-Based Acceptance and Commitment Therapy (ACT) Chronic Pain Intervention. Int J Behav Med 2016; 23:30-8. [PMID: 26135404 DOI: 10.1007/s12529-015-9496-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acceptance and commitment therapy has shown to be effective in chronic pain rehabilitation, and acceptance has been shown to be a key process of change. The influence of treatment dose on acceptance is not clear, and in particular, the effectiveness of a non-intensive treatment (<20 h) in a tertiary pain clinic is required. PURPOSE The purpose of the study was to assess the effectiveness of a low-intensity, acceptance and commitment therapy (ACT) group program for chronic pain. The study sought to compare, at both groups and individual patient levels, changes in acceptance with changes observed in previous ACT studies. METHODS Seventy-one individuals with chronic pain commenced a 9-week ACT-based group program at an outpatient chronic pain service. In addition to acceptance, outcomes included the following: pain catastrophizing, depression, anxiety, quality of life, and pain-related anxiety. To compare the current findings with previous research, effect sizes from seven studies were aggregated using the random-effects model to calculate benchmarks. Reliable change indices (RCIs) were applied to assess change on an individual patient-level. RESULTS The ACT intervention achieved a statistically significant increase in acceptance and medium effect size (d = 0.54) at a group level. Change in acceptance was of a similar magnitude to that found in previous ACT studies that examined interventions with similar treatment hours (<20 h). Results across other outcome measures demonstrated small to medium effect sizes (d = 0.01 to 0.48, mean = 0.26). Reliable improvement in acceptance occurred in approximately one-third (37.2, 90% CI) of patients. Approximately three-quarters (74.3, 90% CI) demonstrated reliable change in at least one of the outcome measures. CONCLUSIONS The low-intensity, group-based ACT intervention was effective at a group level and showed a similar magnitude of change in acceptance to previous ACT studies employing low-intensity interventions. Three-quarters of patients reported reliable change on at least one outcome measure.
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Densham S, Williams D, Johnson A, Turner-Cobb JM. Enhanced psychological flexibility and improved quality of life in chronic fatigue syndrome/myalgic encephalomyelitis. J Psychosom Res 2016; 88:42-7. [PMID: 27521652 DOI: 10.1016/j.jpsychores.2016.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/24/2016] [Accepted: 07/16/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Psychological Flexibility (PF) is a relatively new concept in physical health. It can be defined as an overarching process of being able to accept the presence of wanted/unwanted experiences, choosing whether to change or persist in behaviour in response to those experiences. Associations between processes of PF and quality of life (QoL) have been found in long-term health conditions such as chronic pain, PF has not yet been applied to Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). METHODS Changes in PF, fatigue severity and QoL were examined in one hundred and sixty-five patients with CFS/ME engaged in a six-week outpatient interdisciplinary group treatment programme. Participants were assessed using a series of self-report measures at the start of the start (T1) and end of a six-week programme (T2) and at six months follow up (T3). RESULTS Significant changes in PF and QoL were observed from pre-treatment (T1) to post treatment follow-up (T2 and T3); changes in fatigue severity were observed from T1 to T3 only. Controlling for fatigue severity, changes in the PF dimension of activity/occupational engagement were associated with improvement in QoL at six month follow up (T3) but not at six weeks post programme (T2). CONCLUSION Findings indicate an interdisciplinary group treatment approach for people with CFS/ME may be associated with improved QoL, processes of PF and fatigue severity, supporting a link between PF and long term health conditions. Results highlight links between PF and patient QoL in CFS/ME and the value of interdisciplinary treatment approaches in this patient population.
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Affiliation(s)
- Sarah Densham
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Deborah Williams
- The Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - Anne Johnson
- The Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
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Liu Y, Wang L, Wei Y, Wang X, Xu T, Sun J. Validation of a Chinese version of the Chronic Pain Acceptance Questionnaire (CAPQ) and CPAQ-8 in chronic pain patients. Medicine (Baltimore) 2016; 95:e4339. [PMID: 27537558 PMCID: PMC5370785 DOI: 10.1097/md.0000000000004339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acceptance of chronic pain has increasingly become a significant issue in the field of pain management. Many researchers have suggested that patients with better acceptance of pain are more likely to have better functioning both in physical and psychological status. In many countries, the Chronic Pain Acceptance Questionnaire (CPAQ) and CPAQ-8 have been validated and utilized frequently to measure the pain acceptance of patients with chronic pain. However, the CPAQ and CPAQ-8 yet have not been introduced and validated in Mainland China.In this study, we aimed to translate the English version of the CPAQ into simplified Chinese, make proper cross-cultural adaptations, and validate the psychometric properties of the Chinese version of the CPAQ and the CPAQ-8.The English version of the CPAQ was first linguistically translated and cross-culturally adapted to formulate a Chinese version. Then, we recruited 224 patients from a pain clinic and every participant was asked to finish a series of questionnaires. Finally, statistical analysis was performed to test the psychometric properties of the CPAQ and the CPAQ-8.Both confirmatory factor analysis (CFA) and principal component analysis (PCA) confirmed a 2-factor structure for the CPAQ and the CPAQ-8. Nine out of 10 of the hypotheses were validated for construct validity. The overall intraclass correlation coefficient (ICC) value for the CPAQ and CPAQ-8 were 0.92 and 0.89, respectively. In addition, the Cronbach α values for both the CPAQ and the CPAQ-8 showed excellent test-retest reliability.In conclusion, the original CPAQ was successfully developed into the Chinese version of the CPAQ and CPAQ-8 with excellent validity and reliability. The scores of the CPAQ or CPAQ-8 might be a strong predictor for the physical and psychological function of chronic pain patients. In addition, to improve the satisfaction of surgery patients, we recommend measuring patients' pain acceptance using the CPAQ or CPAQ-8 before and after the surgery. For patients with lower acceptance, psychological interventions may be more effective than treatment that simply reduces symptoms. Finally, we suggest that the Chinese version of the CPAQ and CPAQ-8 are appropriate for use in clinical settings or fundamental research in Mainland China.
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Affiliation(s)
- Yaqun Liu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University
| | - Lei Wang
- Faculty of Health Service
- Central Hospital of Shanghai Zhabei District
| | | | - Xiaolin Wang
- Department of Anesthesiology, Changhai Hospital, Second Military Medical University, f Department of Orthopedics, No. 455 Hospital of PLA, Shanghai, China
| | - Tianming Xu
- Department of Anesthesiology, Changhai Hospital, Second Military Medical University, f Department of Orthopedics, No. 455 Hospital of PLA, Shanghai, China
- Department of Orthopedics, No.455 Hospital of PLA, Shanghai, China
- Correspondence: Tianming Xu, Department of Orthopedics, No. 455 Hospital of PLA, 338 West Huaihai Road, Shanghai, 200052 P.R. China; Jinhai Sun, Faculty of Health Service, Second Military Medical University, No. 800 Xiangyin Road, Shanghai 200433, P.R. China (emails: ; )
| | - Jinhai Sun
- Faculty of Health Service
- Correspondence: Tianming Xu, Department of Orthopedics, No. 455 Hospital of PLA, 338 West Huaihai Road, Shanghai, 200052 P.R. China; Jinhai Sun, Faculty of Health Service, Second Military Medical University, No. 800 Xiangyin Road, Shanghai 200433, P.R. China (emails: ; )
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Bailey RW, Vowles KE, Witkiewitz K, Sowden G, Ashworth J. Examining Committed Action in Chronic Pain: Further Validation and Clinical Utility of the Committed Action Questionnaire. THE JOURNAL OF PAIN 2016; 17:1095-1104. [PMID: 27449073 DOI: 10.1016/j.jpain.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/12/2016] [Accepted: 06/24/2016] [Indexed: 11/15/2022]
Abstract
UNLABELLED Psychosocial treatments for chronic pain conditions, such as Acceptance and Commitment Therapy, have highlighted minimizing pain avoidance behaviors and increasing engagement in valued activities as key treatment targets. In terms of salient processes within Acceptance and Commitment Therapy, committed action is considered essential to the pursuit of a meaningful life, as it entails a flexible persistence over time in living consistently with one's values. To date, however, only 1 study has examined the association between measures of committed action and important aspects of pain-related functioning. The purpose of the present study was to analyze the reliability of the Committed Action Questionnaire (CAQ) in a sample of 149 chronic pain patients, perform a confirmatory analysis of its factor structure, and examine how CAQ scores uniquely account for variance in functioning. Confirmatory factor analyses provided support for a 2-factor model, and regression analyses, which examined the cross-sectional direct effects of the 2 subscales on health-related functioning, indicated that the CAQ accounted for significant variance in functioning after controlling for relevant covariates. Overall, these findings provide further support for the CAQ as a measure of adaptive functioning in those with longstanding pain. PERSPECTIVE This article presents additional evidence for the reliability and validity of the CAQ with chronic pain patients. Confirmatory factor analyses provided support for the 2-factor model, with both subscales demonstrating significant associations with multiple facets of health- and pain-related functioning.
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Affiliation(s)
| | | | | | - Gail Sowden
- IMPACT Pain Service, Haywood Hospital, Stoke-on-Trent, United Kingdom
| | - Julie Ashworth
- IMPACT Pain Service, Haywood Hospital, Stoke-on-Trent, United Kingdom
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Eide H, Leren L, Sørebø Ø. The Norwegian versions of the Chronic Pain Acceptance Questionnaire CPAQ-20 and CPAQ-8 - validation and reliability studies. Disabil Rehabil 2016; 39:1441-1448. [PMID: 27375090 DOI: 10.1080/09638288.2016.1198427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to test the validity and reliability of the translated Norwegian version of the Chronic Pain Acceptance Questionnaire (CPAQ-20) and the shorter version CPAQ-8 based on the same data. METHOD The sample consisted of 120 women with chronic widespread musculoskeletal pain (CWP). The respondents completed CPAQ-20 and visual analogue scales (pain, fatigue, sleep problems and depression), General Health Questionnaire-12, The Pain Catastrophizing Scale, Fibromyalgia Impact Questionnaire and SF-8. Confirmatory factor analyses were performed on a one-factor baseline model, the previous validated CPAQ-20 and CPAQ-8 models, as well as an exploratory generated model based on the current sample. RESULTS The two-factor model of CPAQ-20 and a two-factor model of CPAQ-8 obtained adequate model fit and outperformed the baseline model. The exploratory factor, analysis-generated two-factor model obtained only a marginally better fit, supporting the two-dimensional model of CPAQ-20. CPAQ-20 and CPAQ-8 had Cronbach's alphas between 0.75 (Pain Willingness subscales both versions) and 0.85. Both scales correlated significantly in the hypothesised direction with all the other scales. CONCLUSION The Norwegian versions of CPAQ-20 and CPAQ-8 are reliable assessment tools with good construct validity for measurement of acceptance. Future studies should validate the scales in other Norwegian samples. Implication for Rehabilitation CPAQ-20 and CPAQ-8 are valid Norwegian instruments for measuring acceptance of pain. Acceptance of pain is an important process in the rehabilitation of persons with chronic widespread pain. Treatment models supporting acceptance can now be developed and measured further in Norway.
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Affiliation(s)
- Hilde Eide
- a Faculty of Health Sciences , University College of Southeast-Norway , Drammen , Norway
| | - Lena Leren
- a Faculty of Health Sciences , University College of Southeast-Norway , Drammen , Norway
| | - Øystein Sørebø
- b School of Business and Social Sciences , University College of Southeast-Norway , Hønefoss , Norway
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Rovner G, Vowles KE, Gerdle B, Gillanders D. Latent Class Analysis of the Short and Long Forms of the Chronic Pain Acceptance Questionnaire: Further Examination of Patient Subgroups. THE JOURNAL OF PAIN 2015; 16:1095-105. [DOI: 10.1016/j.jpain.2015.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/08/2015] [Accepted: 07/29/2015] [Indexed: 11/27/2022]
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Neblett R, Mayer TG, Hartzell MM, Williams MJ, Gatchel RJ. The Fear-avoidance Components Scale (FACS): Development and Psychometric Evaluation of a New Measure of Pain-related Fear Avoidance. Pain Pract 2015; 16:435-50. [PMID: 26228238 DOI: 10.1111/papr.12333] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/25/2015] [Indexed: 11/30/2022]
Abstract
Pain-related fear avoidance (FA), a common problem for patients with painful medical conditions, involves pain-related catastrophizing cognitions, hypervigilance, and avoidance behaviors, which can ultimately lead to decreased functioning, depression, and disability. Several patient-reported instruments have been developed to measure FA, but they have been criticized for limited construct validity, inadequate item specificity, lack of cutoff scores, and missing important FA components. The Fear-Avoidance Components Scale (FACS) is a new patient-reported measure designed to comprehensively evaluate FA in patients with painful medical conditions. It combines important components of FA found in prior FA scales, while trying to correct some of their deficiencies, within a framework of the most current FA model. Psychometric evaluation of the FACS found high internal consistency (α = 0.92) and high test/retest reliability (r = 0.90-0.94, P < 0.01). FACS scores differentiated between 2 separate chronic pain patient samples and a nonpatient comparison group. When clinically relevant severity levels were created, FACS severity scores were highly associated with FA-related patient-reported psychosocial and objective lifting performance variables. These results suggest that the FACS is a psychometrically strong and reliable measure that can help healthcare providers assess FA-related barriers to function and recovery.
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Affiliation(s)
| | - Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | | | | | - Robert J Gatchel
- Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, Texas, U.S.A
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Harrison AM, Silber E, McCracken LM, Moss-Morris R. Beyond a physical symptom: the importance of psychosocial factors in multiple sclerosis pain. Eur J Neurol 2015; 22:1443-52. [PMID: 26177836 DOI: 10.1111/ene.12763] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/07/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Pain affects around two-thirds of people with Multiple Sclerosis (pwMS). Biomedical treatments show limited efficacy. A recently developed cognitive-behavioural model of Multiple Sclerosis (MS) pain suggests several psychosocial factors may worsen pain and related disability. The current study investigated whether psychosocial factors drawn from this model explain significant amounts of the variance in pain severity and interference over and above measures of disease severity and pain subtype. METHODS Six hundred and twelve pwMS experiencing pain completed a U.K. wide cross-sectional survey including valid and reliable psychometric questionnaires. Hierarchical regressions determined the relative contribution of disease severity and psychosocial factors to predicting pain severity and interference. RESULTS All psychosocial factors including distress, negative beliefs about pain and its consequences, and avoidance of activity, were related to pain outcomes, explaining a further 24% and 30% of the variance in pain severity and interference after controlling for demographic and disease variables. Findings were similar for neuropathic and non-neuropathic pain subgroups. CONCLUSIONS All pwMS reported significant pain and associated disability even though over 90% were taking pain medication. Psychosocial factors identified as important in predicting pain severity and, to a greater extent, pain interference are potentially modifiable and may be important treatment targets for both pain subtypes.
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Affiliation(s)
- A M Harrison
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - E Silber
- MS Specialist Outpatient Neurology Service, King's College Hospital, London, UK
| | - L M McCracken
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - R Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Comparison of an Online Mindfulness-based Cognitive Therapy Intervention With Online Pain Management Psychoeducation. Clin J Pain 2015; 31:517-27. [DOI: 10.1097/ajp.0000000000000201] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moore H, Stewart I, Barnes-Holmes D, Barnes-Holmes Y, McGuire BE. Comparison of acceptance and distraction strategies in coping with experimentally induced pain. J Pain Res 2015; 8:139-51. [PMID: 25834464 PMCID: PMC4370922 DOI: 10.2147/jpr.s58559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study compared an acceptance-based strategy with a control-based strategy (distraction) in terms of the ability of participants to tolerate a painful stimulus, across two experiments. In addition, participants were either actively encouraged, or not, to link pain tolerance with pursuit of valued goals to examine the impact of pursuing a personally meaningful goal or value on the extent to which pain will be tolerated. METHODS Participants in experiment 1 (n=41) and experiment 2 (n=52) were equally assigned to acceptance or distraction protocols. Further, half the participants in each group generated examples from their own lives in which they had pursued a valued objective, while the other half did not. In experiment 2, the values focus was enhanced to examine the impact on pain tolerance. RESULTS There were no significant differences overall between the acceptance and distraction groups on pain tolerance in either experiment. However, in experiment 2, individuals classified as accepting in terms of general coping style and who were assigned to the acceptance strategy showed significantly better pain tolerance than accepting individuals who were in the distraction condition. Across both experiments, those with strong goal-driven values in both protocols were more tolerant of pain. Participants appeared to have more difficulty adhering to acceptance than to distraction as a strategy. CONCLUSION Acceptance may be associated with better tolerance of pain, but may also be more difficult to operationalize than distraction in experimental studies. Matching coping style and coping strategy may be most effective, and enhancement of goal-driven values may assist in pain coping.
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Affiliation(s)
- Hazel Moore
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Ian Stewart
- School of Psychology, National University of Ireland, Galway, Ireland
| | | | | | - Brian E McGuire
- School of Psychology, National University of Ireland, Galway, Ireland ; Centre for Pain Research, National University of Ireland, Galway, Ireland
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