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Vetterlein A, Hogeterp SA, Monzel M, Reuter M. A matter of personality and point of view: How the interplay of reinforcement sensitivity and general attitudes towards pain impacts the responsivity to acute pain. Eur J Pain 2024; 28:1156-1170. [PMID: 38329141 DOI: 10.1002/ejp.2248] [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: 09/14/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The relatively stable individual differences reflected in Grey's revised reinforcement sensitivity theory (rRST), with foundations in neurophysiology and learning theory, appear particularly applicable to the study of pain. However, remarkably little research has been conducted in this area. In acute pain, activation of the behavioural approach system (BAS), the behavioural inhibition system (BIS) and the fight, flight, freezing system might depend on an individual's evaluation of pain. It was thus hypothesised that higher-order interactions of rRST traits and pain attitudes affect pain responsiveness. METHODS To investigate relationships between rRST traits and pain attitudes and to identify patterns between clusters of participants, we conducted a study in which N = 275 healthy participants filled in Reuter and Montag's rRST-Q and the General Attitudes Towards Pain Inventory (GATPI). Experimental (pressure, electrical, thermal) and self-report data of pain responsiveness were collected in a subsample (N = 113). RESULTS We found significant correlations between rRST-Q and GATPI subscales of up to r = 0.34. Two clusters were identified, significantly differing in rRST-Q and GATPI scores. Pain avoiders, characterized by high BIS, flight, freezing and negative pain attitudes, were found to be significantly more pain sensitive than pain approachers, characterized by high BAS, fight and positive pain attitudes. Moderate effects (d = 0.56 to d = 0.70) were demonstrated in subjective and objective measures and across pain modalities. CONCLUSIONS The present study expands the scientific knowledge on factors influencing pain responsiveness. Future research is needed to confirm implications for chronic pain prevention and therapy, particularly concerning pain avoiders. SIGNIFICANCE We have identified two clusters of participants, pain avoiders and pain approachers, that not only present differential patterns of revised reinforcement theory traits and general attitudes towards pain but also differ in their pain responsiveness. Pain avoiders appeared more pain sensitive compared to pain approachers, both in objective and subjective measurements, with implications for the improvement of chronic pain prevention and therapy.
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Affiliation(s)
- A Vetterlein
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
| | - S A Hogeterp
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
| | - M Monzel
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
| | - M Reuter
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
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2
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Macgregor C, Blane DN, Tulle E, Campbell CL, Barber RJ, Hill O-Connor C, Seenan C. An ecosystem of accepting life with chronic pain: A meta-ethnography. Br J Pain 2024; 18:365-381. [PMID: 39092212 PMCID: PMC11289906 DOI: 10.1177/20494637241250271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.
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Affiliation(s)
- Cassandra Macgregor
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire, Chronic Pain Service, Coatbridge, UK
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emmanuelle Tulle
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Claire L Campbell
- NHS Fife, Pain Management Service, Queen Margaret Hospital, Dunfermline, UK
| | - Ruth J Barber
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire, Chronic Pain Service, Coatbridge, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Fife, Pain Management Service, Queen Margaret Hospital, Dunfermline, UK
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | | | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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3
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Matbouei M, Samsami M, Soleimani M. Breast Cancer Survivors' Experiences of Acceptance Following Recurrence: A Qualitative Content Analysis. Cancer Nurs 2024; 47:E226-E235. [PMID: 36867010 DOI: 10.1097/ncc.0000000000001217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Breast cancer recurrence is a traumatic event for patients, and its treatment depends on the patient's ability to accept the circumstances. OBJECTIVE The aim of this study was to explore how patients experience breast cancer recurrence and go through a process of negotiating acceptance. METHODS This study explored the experiences of 16 patients with breast cancer recurrence regarding the acceptance of recurrence in a hospital in Tehran, Iran. Purposive sampling with maximum diversity was used. Data were collected through semistructured telephone interviews from November 2020 to November 2021 and analyzed using the qualitative content analysis. RESULTS Four themes emerged that described the process of accepting cancer recurrence: (1) response to recurrence (emotional reactions and loss of trust); (2) psychological preparedness (confirmation of medical diagnosis and acceptance of fate); (3) mobilizing supports (using spiritual capacities, utilizing supportive resources, and seeking relationships to promote knowledge); and (4) return to the path of treatment (rebuilding trust and continuation of treatment). CONCLUSIONS The acceptance of breast cancer recurrence is a process that begins with emotional reactions and ends with returning to the treatment path. The patient's psychological preparation, support systems, behavior of healthcare providers, and rebuilding trust are the determining factors in acceptance of recurrence. IMPLICATIONS FOR PRACTICE Nurses can compensate for the failures created in the primary treatment of breast cancer by spending time with patients and paying attention to their concerns, providing effective education, strengthening communication between patients with similar conditions and using the spiritual capacities of patients, and mobilizing the support of family and relatives.
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Affiliation(s)
- Mahsa Matbouei
- Author Affiliations: Student Research Committee, School of Nursing and Midwifery (Ms Matbouei), and Nursing Care Research Center (Dr Soleimani), Semnan University of Medical Sciences, Semnan; and Cancer Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran (Dr Samsami)
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4
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Crombez G, Scott W, De Paepe AL. Knowing What We Are Talking About: The Case of Pain Catastrophizing. THE JOURNAL OF PAIN 2024; 25:591-594. [PMID: 38211846 DOI: 10.1016/j.jpain.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Geert Crombez
- Department of Experimental - Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Whitney Scott
- Health Psychology Section, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, United Kingdom; INPUT Pain Management Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Annick L De Paepe
- Department of Experimental - Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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5
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Sundström FTA, Lavefjord A, Buhrman M, McCracken LM. Associations between psychological flexibility and daily functioning in endometriosis-related pain. Scand J Pain 2024; 24:sjpain-2022-0157. [PMID: 37867345 DOI: 10.1515/sjpain-2022-0157] [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: 11/09/2022] [Accepted: 09/13/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Processes of psychological flexibility (PF) are positively associated with health and wellbeing in several chronic pain disorders. However, these processes have not been investigated in endometriosis, a chronic pain disorder affecting 5-10 % of women worldwide. This study is a preliminary investigation of the associations between PF or psychological inflexibility (PI) and daily functioning in people with a primary diagnosis of endometriosis. METHODS This study is based on a secondary analysis of survey data from Swedish-speaking adult participants with chronic pain recruited online. The current study included only those reporting a diagnosis of endometriosis and significant long-term pain. All participants completed the Multidimensional Psychological Flexibility Inventory (MPFI), a measure of PF and PI, as well as other measures of PF, and measures of pain and daily functioning. Correlation and multiple regression analyses were performed to examine relations of PF and PI with measures of pain and daily functioning. RESULTS In general, PF facet scores from the MPFI did not correlate with pain interference but did correlate with depression, with the exception of acceptance. The overall facets of PI appeared to perform better as correlates and in regression. Established measures of PF performed in correlation and regression analyses generally as has been observed in other chronic pain populations, with significant positive associations. CONCLUSIONS In this preliminary analysis of PF and PI in participants with endometriosis-related pain, these processes appear relevant, especially in understanding depression, but results varied along with the measures used. Specifically, when employing the MPFI, the PI facets emerged as stronger correlates. The findings underscore the potential benefit of incorporating assessments of PF and PI as process variables in endometriosis-research, but also that careful consideration should be given when selecting instruments.
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Affiliation(s)
| | - Amani Lavefjord
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
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6
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Crombez G, Veirman E, Van Ryckeghem D, Scott W, De Paepe A. The effect of psychological factors on pain outcomes: lessons learned for the next generation of research. Pain Rep 2023; 8:e1112. [PMID: 38027466 PMCID: PMC10631620 DOI: 10.1097/pr9.0000000000001112] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/10/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Big data and machine learning techniques offer opportunities to investigate the effects of psychological factors on pain outcomes. Nevertheless, these advances can only deliver when the quality of the data is high and the underpinning causal assumptions are considered. We argue that there is room for improvement and identify some challenges in the evidence base concerning the effect of psychological factors on the development and maintenance of chronic pain. As a starting point, 3 basic tenets of causality are taken: (1) cause and effect differ from each other, (2) the cause precedes the effect within reasonable time, and (3) alternative explanations are ruled out. Building on these tenets, potential problems and some lessons learned are provided that the next generation of research should take into account. In particular, there is a need to be more explicit and transparent about causal assumptions in research. This will lead to better research designs, more appropriate statistical analyses, and constructive discussions and productive tensions that improve our science.
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Affiliation(s)
- Geert Crombez
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Elke Veirman
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dimitri Van Ryckeghem
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Whitney Scott
- Health Psychology Section, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Annick De Paepe
- Department of Experimental—Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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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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8
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Lackner JM, Gudleski GD, Radziwon CD, Krasner SS, Naliboff BD, Vargovich AM, Borden AB, Mayer EA. Cognitive flexibility improves in cognitive behavior therapy for irritable bowel syndrome but not nonspecific education/support. Behav Res Ther 2022; 154:104033. [DOI: 10.1016/j.brat.2022.104033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/06/2023]
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9
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Fjellman-Wiklund A, Söderman K, Lundqvist M, Häger CK. Retrospective experiences of individuals two decades after anterior cruciate ligament injury - a process of re-orientation towards acceptance. Disabil Rehabil 2021; 44:6267-6276. [PMID: 34388952 DOI: 10.1080/09638288.2021.1962415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury. METHODS Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20-29 years ago. RESULTS A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying. CONCLUSION ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.IMPLICATIONS FOR REHABILITATIONMore than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight.Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight.Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour.ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.
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Affiliation(s)
| | - Kerstin Söderman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Mari Lundqvist
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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10
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Ferreira-Valente A, Solé E, Sánchez-Rodríguez E, Sharma S, Pathak A, Jensen MP, Miró J, de la Vega R. Does Pain Acceptance Buffer the Negative Effects of Catastrophizing on Function in Individuals With Chronic Pain? Clin J Pain 2021; 37:339-348. [PMID: 33734146 DOI: 10.1097/ajp.0000000000000930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/22/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Pain catastrophizing and pain acceptance are psychological factors that have been shown to be associated with pain-related outcomes and predict multidisciplinary pain treatment outcomes. However, they are rarely examined in the same study. This study aimed to: (1) assess the independent roles of pain catastrophizingand pain acceptance as predictors of pain intensity, pain interference, and depression; and (2) evaluate the potential moderating role of pain acceptance on the association between pain catastrophizing and both pain and function. MATERIALS AND METHODS A sample of 467 adults with chronic pain completed an online survey including measures of pain intensity, pain interference, depression, pain catastrophizing, and pain acceptance. RESULTS Pain catastrophizing and pain acceptance were independent predictors of pain interference. Only pain catastrophizing and the activity engagement domain of pain acceptance were independent predictors of pain intensity and depression. Activity engagement moderated the association between pain catastrophizing and depression, indicating a buffering effect on the negative effects of catastrophizing on depression. Pain willingness moderated the association between pain catastrophizing and pain interference, such that endorsing low pain willingness may override any negative effects of pain catastrophizing. DISCUSSION The findings suggest that pain catastrophizing and pain acceptance are independently important to adjustment to chronic pain. Research is needed to determine if treatments that target both for change are more effective than treatments that target only one.
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Affiliation(s)
- Alexandra Ferreira-Valente
- William James Center for Research, ISPA-Instituto Universitário, Lisbon, Portugal
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Ester Solé
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
| | - Elisabet Sánchez-Rodríguez
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
| | - Saurab Sharma
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Anupa Pathak
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Jordi Miró
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
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11
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Van Ryckeghem DML. Acceptance is not acceptance, but acceptance! Eur J Pain 2020; 25:3-4. [PMID: 33037708 PMCID: PMC7839685 DOI: 10.1002/ejp.1672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Dimitri M L Van Ryckeghem
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.,Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
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12
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Abstract
Pain is a major source of global suffering, with women bearing the greatest burden. Alongside biology, psychological and social factors, including gender, help explain these differences. However, there has been no direct attempt to develop a unified social psychological model of men and women's pain. By drawing on approaches to both gender and pain, a gender context model of pain is presented. It proposes that pain is partly influenced by the gender context in which it occurs, which operates at both individual and interpersonal levels. The model is used to structure an appraisal of the existing evidence around gender and pain, and explore whether the model helps explain why such variation occurs. It is argued that despite evidence for an association between gender and pain, there are empirical gaps that need to be addressed. Implications and directions for future investigations into sex, gender and pain are considered.
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Affiliation(s)
- Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
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13
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Vowles KE, Kruger ES, Bailey RW, Sowden G, Ashworth J, Hickman J, McCracken LM. Initial evaluation of the Chronic Pain Acceptance Questionnaire - 2. Eur J Pain 2020; 24:2027-2036. [PMID: 32816389 DOI: 10.1002/ejp.1650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/05/2022]
Abstract
Greater acceptance of chronic pain is associated with lesser levels of pain-related distress and disability and better overall functioning. Pain acceptance is most often assessed using the Chronic Pain Acceptance Questionnaire (CPAQ), which includes both an eight-item short form (CPAQ-8) and a twenty item parent measure (CPAQ-20). This study derived a two-item CPAQ for use in busy clinical settings and for repeated measurement during treatment, the CPAQ-2. An Item Response Theory (IRT) approach was used to identify the strongest items from the CPAQ-20, one from each of its two subscales. Next, regression analyses were conducted to evaluate the utility of the CPAQ-2 by examining variance accounted for in the CPAQ-8, CPAQ-20, and in measures of depression, pain-related fear, physical disability, and psychosocial disability. Four clinical databases were combined (N = 1,776) for the analyses. Items 9 and 14 were identified as the strongest CPAQ-20 items in the IRT analyses. The sum score of these two items accounted for over 60% of the variance in the CPAQ-8 and CPAQ-20. Furthermore, this score accounted for significant variance in measures of depression, pain-related fear, physical disability, and psychosocial disability after controlling for data collection method (i.e. in clinic or online), participant age, education, pain duration and usual pain. Finally, the amount of variance accounted for by the CPAQ-2 was comparable to that accounted for by both the CPAQ-8 and CPAQ-20. These results provide initial support for the CPAQ-2 and suggest that it is well-suited as a brief assessment of chronic pain acceptance. SIGNIFICANCE: The most frequently used measure of pain acceptance is the CPAQ, which includes both an eight-item short form, the CPAQ-8, and a longer twenty item parent measure, the CPAQ-20. The present study sought to derive a two-item measure of the CPAQ for use in busy clinical settings and for repeated measurement during treatment, the CPAQ-2. An IRT approach was used to identify the strongest items from the CPAQ-20, one from each of its two subscales in a large sample of 1,776 individuals with chronic pain. The two item measure accounted for significant variance in measures of depression, pain-related fear, physical disability, and psychosocial disability. The brief measure will be useful in assessing pain acceptance in busy clinical setting and longitudinal designs.
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Affiliation(s)
- Kevin E Vowles
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University - Belfast, Belfast, UK
| | - Eric S Kruger
- Division of Physical Therapy, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Robert W Bailey
- VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Gail Sowden
- IMPACT Pain Service, Midlands Partnership NHS Foundation Trust, National Health Service, Stoke-on-Trent, UK
| | - Julie Ashworth
- IMPACT Pain Service, Midlands Partnership NHS Foundation Trust, National Health Service, Stoke-on-Trent, UK
| | - Jayne Hickman
- IMPACT Pain Service, Midlands Partnership NHS Foundation Trust, National Health Service, Stoke-on-Trent, UK
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14
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Crombez G, De Paepe AL, Veirman E, Eccleston C, Verleysen G, Van Ryckeghem DM. Let's talk about pain catastrophizing measures: an item content analysis. PeerJ 2020; 8:e8643. [PMID: 32181053 PMCID: PMC7060750 DOI: 10.7717/peerj.8643] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Concerns have been raised about whether self-report measures of pain catastrophizing reflect the construct as defined in the cognitive-behavioral literature. We investigated the content of these self-report measures; that is, whether items assess the construct 'pain catastrophizing' and not other theoretical constructs (i.e., related constructs or pain outcomes) using the discriminant content validity method. METHOD Items (n = 58) of six pain catastrophizing measures were complemented with items (n = 34) from questionnaires measuring pain-related worrying, vigilance, pain severity, distress, and disability. Via an online survey, 94 participants rated to what extent each item was relevant for assessing pain catastrophizing, defined as "to view or present pain or pain-related problems as considerably worse than they actually are" and other relevant constructs (pain-related worrying, vigilance, pain severity, distress, and disability). RESULTS Data were analyzed using Bayesian hierarchical models. The results revealed that the items from pain-related worrying, vigilance, pain severity, distress, and disability questionnaires were distinctively related to their respective constructs. This was not observed for the items from the pain catastrophizing questionnaires. The content of the pain catastrophizing measures was equally well, or even better, captured by pain-related worrying or pain-related distress. CONCLUSION Based upon current findings, a recommendation may be to develop a novel pain catastrophizing questionnaire. However, we argue that pain catastrophizing cannot be assessed by self-report questionnaires. Pain catastrophizing requires contextual information, and expert judgment, which cannot be provided by self-report questionnaires. We argue for a person-centered approach, and propose to rename 'pain catastrophizing' measures in line with what is better measured: 'pain-related worrying'.
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Affiliation(s)
- Geert Crombez
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Annick L. De Paepe
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Elke Veirman
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | | | - Gregory Verleysen
- Ghent University, Research Support Office, Faculty of Psychology and Educational Sciences, Ghent, Belgium
| | - Dimitri M.L. Van Ryckeghem
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Institute for Health and Behaviour, INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Medicate or Meditate? Greater Pain Acceptance is Related to Lower Pain Medication Use in Persons With Chronic Pain and Spinal Cord Injury. Clin J Pain 2019; 34:357-365. [PMID: 28877136 DOI: 10.1097/ajp.0000000000000550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES There is little information about whether use of pain self-management skills that are common targets of psychosocial interventions for pain are associated with reduced reliance on pain medications. The aim of this study was to test whether higher chronic pain acceptance, which is a readily modified pain self-management approach, is related to lower use of pain medications (eg, opioid medications, and gabapentinoids) in a sample with chronic pain and spinal cord injury (SCI). MATERIALS AND METHODS This is a cross-sectional survey study of pain medication use, pain severity and distribution (Brief Pain Inventory [BPI]), depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), and chronic pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]) administered to a sample of 120 adults with chronic pain and SCI. RESULTS Regression results indicated that, above and beyond the effects of pain intensity, pain distribution, and depressive symptoms, higher pain acceptance was related to lower use of all types of pain medications, and lower odds of using opioid medications or gabapentinoids. Pain intensity was not related to pain medication use, but greater pain distribution was related to using more pain medications in general and to greater odds of using gabapentinoids. DISCUSSION Findings from this study indicate that those with chronic pain and SCI who have a more accepting orientation to pain are less reliant on pain medications, and thereby experience lower risks associated with medication consumption. Longitudinal, daily process, and clinical trial studies are needed to better understand the association between pain acceptance and pain medication consumption.
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16
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Lin J, Klatt LI, McCracken LM, Baumeister H. Psychological flexibility mediates the effect of an online-based acceptance and commitment therapy for chronic pain: an investigation of change processes. Pain 2019; 159:663-672. [PMID: 29320375 DOI: 10.1097/j.pain.0000000000001134] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One way to improve treatment effects of chronic pain is to identify and improve control over mechanisms of therapeutic change. One treatment approach that includes a specific proposed mechanism is acceptance and commitment therapy (ACT) with its focus on increasing psychological flexibility (PF). The aim of the present study was to examine the role of PF as a mechanism of change in ACT. This is based on mediation analyses of data from a previously reported randomized controlled trial, evaluating the effectiveness of an ACT-based online intervention for chronic pain (ACTonPain). We performed secondary analyses on pretreatment, posttreatment, and follow-up data from 302 adults, receiving a guided (n = 100) or unguided (n = 101) version of ACTonPain, or allocated to the waitlist control group (n = 101). Structural equation modelling and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment through pretreatment and posttreatment changes in the latent construct reflecting PF. The latent construct consisted of data from the Chronic Pain Acceptance Questionnaire and the Acceptance and Action Questionnaire. The outcomes were pretreatment to follow-up changes in pain interference, anxiety, depression, pain, and mental and physical health. Structural equation modelling analyses revealed that changes in PF significantly mediated pretreatment to follow-up changes in all outcomes in the intervention groups compared with waitlist (standardized estimates ranged from I0.16I to I0.69I). Global model fit yielded modest but acceptable results. Findings are consistent with the theoretical framework behind ACT and contribute to growing evidence, supporting a focus on PF to optimize treatment effects.
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Affiliation(s)
- Jiaxi Lin
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.,Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Laura-Isabelle Klatt
- Department of Ergonomics, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Lance M McCracken
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,INPUT Pain Management, Guy's and St Thomas' NHS Foundation Trust London, London, United Kingdom
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Ulm, Ulm, Germany
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Litrownik D, Gilliam E, Berkowitz D, Yeh GY, Wayne PM. Reporting of Protocol Rationale and Content Validity in Randomized Clinical Trials of T'ai Chi: A Systematic Evaluation. J Altern Complement Med 2019; 25:370-376. [PMID: 30835135 DOI: 10.1089/acm.2018.0389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mind-body exercise interventions are typically multimodal, complex, and pluralistic, and few have been developed with the goal of therapeutically targeting a specific medical population. It is thus important that clinical trials evaluating mind-body interventions provide some justification for the use of the specific protocol being evaluated. OBJECTIVES This article reports the results of a systematic review of the quality of reporting of protocol rationale and content validity for using a specific t'ai chi protocol in a randomized controlled trial (RCT). METHODS Electronic literature searches were conducted using PubMed/MEDLINE, EBSCOhost, and the Cochrane Library from inception through June 2015. Search terms were Tai Chi, Taiji, Tai Chi Chuan; searches were limited to English-language RCTs. Inclusion and exclusion of trials were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors assessed the level of reporting with respect to t'ai chi protocol validation using a 5-point grading system based on whether (1) a specific protocol was mentioned, (2) rationale for the specific protocol was stated and supported, and (3) formal evaluation for content validity was conducted. RESULTS There was significant heterogeneity in the quality of reporting related to protocol rationale and content validity. A total of 171 publications were identified. Studies met between 0 and 4 validity criteria (of possible 5, more indicating better quality), with a mean of 2.52 (±SD 1.2) and median of 3. Twenty (12%) trials did not mention a specific t'ai chi protocol, 10 (6%) trials met 0 of 5 criteria, and 47 (31%) studies met 4 of 5 criteria. Formal validity assessments were employed in only one trial. CONCLUSIONS The poor quality of protocol rationale and content validity reporting limits our ability to accurately evaluate the evidence of t'ai chi as a therapeutic intervention. The development of formal guidelines for developing and reporting intervention validity for multimodal mind-body exercises like t'ai chi may improve the quality and interpretability of research.
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Affiliation(s)
- Daniel Litrownik
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elizabeth Gilliam
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Danielle Berkowitz
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gloria Y Yeh
- 1 Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peter M Wayne
- 2 Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Gauntlett-Gilbert J, Alamire B, Duggan GB. Pain Acceptance in Adolescents: Development of a Short Form of the CPAQ-A. J Pediatr Psychol 2018; 44:453-462. [PMID: 30496433 DOI: 10.1093/jpepsy/jsy090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal United Hospitals Bath, Royal National Hospital for Rheumatic Diseases
- Faculty for Health and Applied Sciences, University of the West of England
| | - Batool Alamire
- Bath Centre for Pain Services, Royal United Hospitals Bath, Royal National Hospital for Rheumatic Diseases
| | - Geoffrey B Duggan
- Bath Centre for Pain Services, Royal United Hospitals Bath, Royal National Hospital for Rheumatic Diseases
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19
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Chronic pain as embodied defence: implications for current and future psychological treatments. Pain 2018; 159 Suppl 1:S17-S23. [DOI: 10.1097/j.pain.0000000000001286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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20
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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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21
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Fisher E, Heathcote LC, Eccleston C, Simons LE, Palermo TM. Assessment of Pain Anxiety, Pain Catastrophizing, and Fear of Pain in Children and Adolescents With Chronic Pain: A Systematic Review and Meta-Analysis. J Pediatr Psychol 2018; 43:314-325. [PMID: 29049813 PMCID: PMC6927870 DOI: 10.1093/jpepsy/jsx103] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To conduct a systematic review of pain anxiety, pain catastrophizing, and fear of pain measures psychometrically established in youth with chronic pain. The review addresses three specific aims: (1) to identify measures used in youth with chronic pain, summarizing their content, psychometric properties, and use; (2) to use evidence-based assessment criteria to rate each measure according to the Society of Pediatric Psychology (SPP) guidelines; (3) to pool data across studies for meta-analysis of shared variance in psychometric performance in relation to the primary outcomes of pain intensity, disability, generalized anxiety, and depression. Methods We searched Medline, Embase, PsycINFO, and relevant literature for possible studies to include. We identified measures studied in youth with chronic pain that assessed pain anxiety, pain catastrophizing, or fear of pain and extracted the item-level content. Study and participant characteristics, and correlation data were extracted for summary and meta-analysis, and measures were rated using the SPP evidence-based assessment criteria. Results Fifty-four studies (84 papers) met the inclusion criteria, including seven relevant measures: one assessed pain anxiety, three pain catastrophizing, and three fear of pain. Overall, five measures were rated as "well established." We conducted meta-analyses on four measures with available data. We found significant positive correlations with the variables pain intensity, disability, generalized anxiety, and depression. Conclusion Seven measures are available to assess pain anxiety, pain catastrophizing, and fear of pain in young people with chronic pain, and most are well established. We present implications for practice and directions for future research.
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Affiliation(s)
- Emma Fisher
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath
- Department of Clinical and Health Psychology, Ghent University
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| | - Tonya M Palermo
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
- Departments of Anesthesiology and Pain Medicine, Psychiatry, and Pediatrics, University of Washington
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22
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Jensen MP, Ward LC, Thorn BE, Ehde DM, Day MA. Measuring the Cognitions, Emotions, and Motivation Associated With Avoidance Behaviors in the Context of Pain: Preliminary Development of the Negative Responsivity to Pain Scales. Clin J Pain 2017; 33:325-334. [PMID: 27428549 DOI: 10.1097/ajp.0000000000000407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We recently proposed a Behavioral Inhibition System-Behavioral Activation System (BIS-BAS) model to help explain the effects of pain treatments. In this model, treatments are hypothesized to operate primarily through their effects on the domains within 2 distinct neurophysiological systems that underlie approach (BAS) and avoidance (BIS) behaviors. Measures of the model's domains are needed to evaluate and modify the model. METHODS An item pool of negative responses to pain (NRP; hypothesized to be BIS related) and positive responses (PR; hypothesized to be BAS related) were administered to 395 undergraduates, 325 of whom endorsed recurrent pain. The items were administered to 176 of these individuals again 1 week later. Analyses were conducted to develop and validate scales assessing NRP and PR domains. RESULTS Three NRP scales (Despondent Response to Pain, Fear of Pain, and Avoidant Response to Pain) and 2 PR scales (Happy/Hopeful Responses and Approach Response) emerged. Consistent with the model, the scales formed 2 relatively independent overarching domains. The scales also demonstrated excellent internal consistency, and associations with criterion variables supported their validity. However, whereas the NRP scales evidenced adequate test-retest stability, the 2 PR scales were not adequately stable. DISCUSSION The study yielded 3 brief scales assessing NRP, which may be used to further evaluate the BIS-BAS model and to advance research elucidating the mechanisms of psychosocial pain treatments. The findings also provide general support for the BIS-BAS model, while also suggesting that some minor modifications in the model are warranted.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation, University of Washington, Seattle, WA
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23
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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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Day MA, Thorn BE. Mindfulness-based cognitive therapy for headache pain: An evaluation of the long-term maintenance of effects. Complement Ther Med 2017; 33:94-98. [PMID: 28735832 DOI: 10.1016/j.ctim.2017.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/21/2017] [Accepted: 06/30/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This study aimed to examine the durability of gain patterns following an 8-week Mindfulness-Based Cognitive Therapy (MBCT) for headache pain program. DESIGN A secondary analysis of a randomized controlled trial was conducted. Participants (N=19) were individuals with headache pain who completed both the MBCT program as well as a 6-month follow-up assessment at a headache clinic or a university psychology clinic. Standardized measures of the primary outcomes (pain intensity and pain interference) and secondary outcomes (pain catastrophizing, mindfulness, activity engagement, pain willingness, and self-efficacy) were administered. Paired-samples t tests and effect sizes were examined. RESULTS Significant (uncorrected ps<.05) pre- to post-treatment gains were found for pain intensity, pain interference, pain catastrophizing, activity engagement and self-efficacy, and these gains were maintained at 6-months post-treatment. Effect sizes for the significant changes from pre- to post-treatment, and from pre-treatment to follow-up were mostly consistent across epochs (.62≤ds≤-1.40), indicating steady maintenance of effects. Improvement in mindfulness and pain willingness was non-significant immediately post-treatment and at follow-up, with small effects observed. CONCLUSIONS This study adds to a growing body of literature supporting the durability of MBCT for painful conditions. Results indicated a consistent pattern of maintenance of treatment-related gains across a number of key pain-related outcomes. Future research with a larger sample is needed to investigate the mechanisms underlying these continued gains in order to optimize targeted relapse-prevention.
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Affiliation(s)
- Melissa A Day
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
| | - Beverly E Thorn
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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25
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Elander J, Richardson C, Morris J, Robinson G, Schofield M. Motivational and behavioural models of change: A longitudinal analysis of change among men with chronic haemophilia-related joint pain. Eur J Pain 2017; 21:1384-1396. [DOI: 10.1002/ejp.1040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/07/2022]
Affiliation(s)
- J. Elander
- Centre for Psychological Research; University of Derby; UK
| | - C. Richardson
- School of Psychology; University of Central Lancashire; Preston UK
| | | | - G. Robinson
- Department of Psychology; London Metropolitan University; UK
| | - M.B. Schofield
- Centre for Psychological Research; University of Derby; UK
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Abstract
There is a strong tradition of therapy development and evaluation in the field of psychological interventions for chronic pain. However, despite this research production, the effects of treatments remain uncertain, and treatment development has stalled. This review summarises the current evidence but focusses on promising areas for improvement. Advancing psychological therapies for chronic pain will come from a radical re-imagining of the content, delivery, place, and control of therapy. The next generation of therapeutic interventions will also need alternative methods of measurement and evaluation, and options are discussed.
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Affiliation(s)
- Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK.,Department of Clinical-Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - Geert Crombez
- Centre for Pain Research, University of Bath, Bath, UK.,Department of Clinical-Experimental and Health Psychology, Ghent University, Gent, Belgium
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Day MA, Ward LC, Thorn BE, Lang CP, Newton-John TRO, Ehde DM, Jensen MP. The Pain-Related Cognitive Processes Questionnaire: Development and Validation. PAIN MEDICINE 2017; 19:269-283. [DOI: 10.1093/pm/pnx010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cary MA, Brittain DR, Gyurcsik NC. Differences in psychosocial responses to pain between sufficiently and insufficiently active adults with arthritis. Psychol Health 2017; 32:765-780. [PMID: 28276735 DOI: 10.1080/08870446.2017.1300258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Adults with arthritis struggle to meet the physical activity recommendation for disease self-management. Identifying psychosocial factors that differentiate adults who meet (sufficiently active) or do not meet (insufficiently active) the recommendation is needed. This study sought to examine differences in psychosocial responses to arthritis pain among adults who were sufficiently or insufficiently active. DESIGN This prospective study included adults with medically diagnosed arthritis (N = 136, Mage = 49.75 ± 13.88 years) who completed two online surveys: (1) baseline: pain and psychosocial responses to pain and (2) two weeks later: physical activity. MAIN OUTCOME MEASURES Psychosocial responses examined in this study were psychological flexibility in response to pain, pain anxiety and maladaptive responses to pain anxiety. RESULTS A between-groups MANCOVA comparing sufficiently active (n = 87) to insufficiently active (n = 49) participants on psychosocial responses, after controlling for pain intensity, was significant (p = .005). Follow-up ANOVA's revealed that sufficiently active participants reported significantly higher psychological flexibility and used maladaptive responses less often compared to insufficiently active participants (p's < .05). CONCLUSIONS These findings provide preliminary insight into the psychosocial profile of adults at risk for nonadherence due to their responses to arthritis pain.
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Affiliation(s)
- Miranda A Cary
- a College of Kinesiology, University of Saskatchewan , Saskatoon , Canada
| | - Danielle R Brittain
- b Community Health Program , Colorado School of Public Health, University of Northern Colorado , Greeley , CO , United States
| | - Nancy C Gyurcsik
- a College of Kinesiology, University of Saskatchewan , Saskatoon , Canada
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Pain Acceptance Decouples the Momentary Associations Between Pain, Pain Interference, and Physical Activity in the Daily Lives of People With Chronic Pain and Spinal Cord Injury. THE JOURNAL OF PAIN 2017; 18:319-331. [DOI: 10.1016/j.jpain.2016.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 02/08/2023]
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30
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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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Do Flexible Goal Adjustment and Acceptance Help Preserve Quality of Life in Patients with Multiple Sclerosis? Int J Behav Med 2015; 23:333-339. [DOI: 10.1007/s12529-015-9519-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Biguet G, Nilsson Wikmar L, Bullington J, Flink B, Löfgren M. Meanings of "acceptance" for patients with long-term pain when starting rehabilitation. Disabil Rehabil 2015; 38:1257-67. [PMID: 26305503 DOI: 10.3109/09638288.2015.1076529] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme. METHODS Six women and three men with long-term pain were interviewed. The interviews were analysed according to interpretative phenomenological analysis. RESULTS The analysis revealed three different meaning structures, first: acceptance as a process of personal empowerment, "the only way forward". Here, the individuals expressed that the body felt integrated: a trusting cooperation between self and body gave rise to hope. Second: acceptance as an equivocal project, a possible but challenging way forward. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also uncertainty and doubt about one's ability with a body ambiguous and confusing, difficult but important to understand. Third, in acceptance as a threat and a personal failure, "no way forward" the integration of the aching body in sense of self was impossible and pain was incomprehensible, unacceptable and unfair. Pain was the cause of feeling stuck in the body, affecting the sense of self and the person's entire life. CONCLUSIONS The meaning of acceptance was related to acceptance of the persistency of pain, to how the individual related to the lived body and the need for changes in core aspects of self, and to the issue of whether to include others in the struggle of learning to move on with a meaningful life. IMPLICATIONS FOR REHABILITATION Healthcare professionals should be aware that individuals with long-term pain conceptualize and hold different meanings of acceptance when starting rehabilitation; this should be considered and addressed in rehabilitation programmes. The meaning given to acceptance is related to the experience of the lived body and the sense of self, as well as to getting legitimization/acceptance by others; therefore these aspects need to be considered during rehabilitation. The process of achieving acceptance seems to embrace different processes which can be understood as, and facilitated by, an embodied learning process. The bodily existential challenges presented in the present study, for example to develop an integrated and cooperative relationship with the painful body, can inspire health professionals to develop interventions and communication strategies focusing on the lived body. A wide range of competencies in rehabilitation clinics seems to be needed.
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Affiliation(s)
- Gabriele Biguet
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - Lena Nilsson Wikmar
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - Jennifer Bullington
- b Department of Health Care Sciences, Ersta Sköndal University College , Stockholm , Sweden , and
| | - Berit Flink
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - Monika Löfgren
- c Department of Clinical Sciences , Danderyd Hospital, Karolinska Institutet , Stockholm , Sweden
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Boerner KE, Rosen NO. Acceptance of vulvovaginal pain in women with provoked vestibulodynia and their partners: associations with pain, psychological, and sexual adjustment. J Sex Med 2015; 12:1450-62. [PMID: 25869256 DOI: 10.1111/jsm.12889] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Provoked vestibulodynia (PVD) is a common vulvovaginal pain condition associated with negative psychological and sexual consequences for affected women and their sexual partners. Greater pain acceptance has been found to be associated with better functional and psychological outcomes in individuals with chronic pain, and acceptance-based strategies are being increasingly incorporated into treatment protocols. The present study is a novel investigation of pain acceptance in PVD couples. AIM The aim was to examine the associations between acceptance of vulvovaginal pain and women's pain during intercourse, as well as the psychological and sexual adjustment of both women with PVD and their partners. METHODS Sixty-one couples (M(age) for women = 27.95 years, SD = 5.87; M(age) for men = 30.48 years, SD = 6.70) in which the woman was diagnosed with PVD completed the Chronic Pain Acceptance Questionnaire, in reference to women's vulvovaginal pain. Women also rated their pain during intercourse, and couples completed measures of anxiety, depression, sexual function, and sexual satisfaction. MAIN OUTCOME MEASURES Dependent measures were (i) women's self-reported pain during intercourse on a numerical rating scale; (ii) State-Trait Anxiety Inventory trait subscale; (iii) Beck Depression Inventory-II; (iv) Derogatis Interview for Sexual Functioning; and (v) Global Measure of Sexual Satisfaction Scale. RESULTS Women's greater pain acceptance was associated with their lower self-reported pain during intercourse, controlling for partner's pain acceptance. Greater pain acceptance among women was associated with their own lower anxiety and depression, greater sexual functioning, as well as their own and their partner's greater sexual satisfaction, controlling for the partner's pain acceptance. Additionally, greater pain acceptance among male partners was associated with their own lower depression. CONCLUSIONS Findings suggest that psychological interventions for PVD should target increasing couples' vulvovaginal pain acceptance in order to improve women's pain and the sexual and psychological functioning of both members of the couple.
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Affiliation(s)
- Katelynn E Boerner
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Natalie O Rosen
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Obstetrics and Gynecology, IWK Health Centre, Halifax, Nova Scotia, Canada
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