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Ramírez-Maestre C, Barrado-Moreno V, Esteve R, Serrano-Íbañez ER, de la Vega R, Ruiz-Párraga GT, Fernández-Baena M, Jensen MP, López-Martínez AE. Vulnerability Factors, Adjustment, and Opioid Misuse in Chronic Noncancer Pain Individuals. THE JOURNAL OF PAIN 2024:104606. [PMID: 38871145 DOI: 10.1016/j.jpain.2024.104606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/15/2024]
Abstract
Several person variables predate injury or pain onset that increase the probability of maladjustment to pain and opioid misuse. The aim of this study was to evaluate the role of 2 diathesis variables (impulsiveness and anxiety sensitivity [AS]) in the adjustment of individuals with chronic noncancer pain and opioid misuse. The sample comprised 187 individuals with chronic noncancer pain. The hypothetical model was tested using correlation and structural equation modeling analyses. The results show a significant association between impulsiveness and AS and all the maladjustment variables, and between impulsiveness and AS and opioid misuse and craving. However, although the correlation analysis showed a significant association between adjustment to pain and opioid misuse, the structural equation modeling analysis showed a nonsignificant association between them (as latent variables). The findings support the hypothesis that both impulsiveness and AS are vulnerability factors for maladaptive adjustment to chronic pain and opioid misuse. PERSPECTIVE: This article adds to the empirical literature by including AS and impulsiveness as antecedent variables in a model of dual vulnerability to chronic pain maladjustment and opioid misuse. The findings suggest the potential utility of assessing both factors in individuals in the first stages of chronic pain.
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Affiliation(s)
- Carmen Ramírez-Maestre
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - Victoria Barrado-Moreno
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain
| | - Rosa Esteve
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Elena R Serrano-Íbañez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Rocío de la Vega
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Gema T Ruiz-Párraga
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Alicia E López-Martínez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Málaga, Andalucía Tech, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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Rogers AH, Smit T, Bakhshaie J, Zvolensky MJ. Momentary Emotion Regulation Strategies and Pain Experience Among Adults With Chronic Pain: An Ecological Momentary Assessment Study. Clin J Pain 2024; 40:269-277. [PMID: 38345471 PMCID: PMC11015978 DOI: 10.1097/ajp.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/30/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES The intention of this study was to characterize the real-time momentary relationship between emotion regulation strategies and the pain experience (ie intensity, interference, and negative affect) among adults with chronic pain. Chronic pain is a significant public health concern. Psychological treatments are effective for treating chronic pain, but long-term follow-up studies are limited, and treatment effect sizes are small. Identifying modifiable treatment targets, such as emotion regulation (ER), is critical to improve interventions. ER (ie, cognitive and attentional strategies to modulate or maintain emotional experience) has been linked to psychopathology and pain experience in adults. Yet, the existing work is limited and has largely focused on the relationship between emotional experience, not ER, and pain. MATERIALS AND METHODS The current study utilized ecological momentary assessment 53 adults with chronic pain. Participants completed ecological momentary assessments of pain experience and ER strategies 5 times a day for 7 days. Associations by specific strategy type were also examined, highlighting the importance of worry, experiential avoidance, rumination, and expressive suppression in pain experience. RESULTS Results of the current study provide evidence for the association between within-person maladaptive ER strategies and pain intensity ( b = 2.11, SE = 0.37, P < 0.001), pain interference ( b = 1.25, SE = 0.40, P = 0.002), and pain-related negative affect ( b = 2.20, SE = 0.41, P < 0.001). (77.4% females; M age = 27.10 y, SD = 5.16 y). DISCUSSION Given that ER is readily targeted in psychological treatments for chronic pain, the results from the current study provide initial evidence to target these ER strategies in treatment.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA
| | | | - Jafar Bakhshaie
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Michael J Zvolensky
- Department of Psychology
- HEALTH Institute, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kahtan H, Jordan A, Forget P. Is pain ever acceptable? A qualitative exploration concerning adult perceptions of chronic pain. Eur J Pain 2024. [PMID: 38400800 DOI: 10.1002/ejp.2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Although the challenges of living with chronic pain are widely documented within existing literature, to our knowledge, the acceptability of pain for people living with persistent pain, has not been fully explored. The current study aims to explore what 'acceptable pain' means to adults living with chronic non-cancer pain (CPCP). METHODS A total of 117 participants (aged 21 to 77 years) worldwide were recruited using opportunity sampling. Participants completed an online qualitative survey. Qualitative analysis of the data used inductive reflexive thematic analysis. RESULTS Two themes were generated. The first theme-'I grin and bear it', described participants' desire and drive to push through their pain to live their daily lives to the best of their ability. Contrastingly, the second theme-'Thriving versus surviving', placed greater importance on leading meaningful and happy lives despite living with chronic pain. The acceptability of pain was found to be influenced by various factors including, but not limited to, pain severity, mental health, functionality, productivity and quality of life. CONCLUSIONS It can be difficult to identify when a clinically significant change in pain has occurred from numerical pain rating scales. We have identified two themes and a number of factors influencing the acceptability of pain. Understanding individuals' unique perceptions of what constitutes 'acceptable pain' is crucial for clinicians when assessing and managing chronic pain. Pain is a highly subjective experience, and what one person considers acceptable may differ significantly from another person's perspective. Recommendations to improve healthcare services for adults living with CNCP are proposed and directions for future research are explored. SIGNIFICANCE Adults with CNCP have unique experiences of living with and managing their chronic pain. CNCP was found to affect biological, psychological, and social aspects of an individual's life. The acceptability of pain exists on a continuum where adjacent parts are not noticeably different from each other, but the extremes of the continuum appear very distinct. The acceptability of pain is determined by the different factors that influence an individuals' ability to function on a day-to-day basis as well as their quality of life. While acceptable pain and manageable pain represent distinct aspects of the pain experience, the relationship between them is complex and plays a crucial role in how individuals cope with and adapt to chronic pain.
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Affiliation(s)
- Hanaa Kahtan
- Department of Psychology, University of Bath, Bath, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | - Patrice Forget
- Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Anaesthesia, NHS Grampian, University of Aberdeen, Aberdeen, UK
- Pain and Opioids after Surgery (PANDOS) ESAIC Research Group, European Society of Anaesthesiology and Intensive Care, Brussels, Belgium
- IMAGINE UR UM 103, Anesthesia Critical Care, Emergency and Pain Medicine Division, Nimes University Hospital, Montpellier University, Nimes, France
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Gerdle B, Dragioti E, Rivano Fischer M, Ringqvist Å. Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Pain Res 2024; 17:83-105. [PMID: 38196970 PMCID: PMC10775695 DOI: 10.2147/jpr.s438260] [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] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
Background Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008-2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims. Results Changes in acceptance (β:0.424-0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177-0.233; all P<0.001) and changes in fear-avoidance (β: -0.152- -0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator. Discussion and Conclusion Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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Al-Arfaj SK, Abdallah AF, Abdulla FA. Psychometric properties of an Arabic translation of the chronic pain acceptance questionnaire (CPAQ) in a sample of patients with chronic pain. Disabil Rehabil 2023:1-12. [PMID: 38100318 DOI: 10.1080/09638288.2023.2293987] [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: 05/18/2022] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Chronic pain (CP) acceptance is a major factor in determining the well-being of patients with chronic pain. The chronic pain acceptance questionnaire (CPAQ) was translated and validated into Arabic (CPAQ-Ar). METHODS 244 patients with CP completed the CPAQ-Ar, the Beck Depression Inventory-II (BDI-II), the short form health survey (SF-36), the Pain Catastrophizing Scale (PCS), the Pittsburgh Sleep Quality Index (PSQI), the Modified Fatigue Impact Scale (MFIS), and the Depression Anxiety Stress Scale 21 (DASS-21). 110 patients completed the CPAQ-Ar twice separated by two weeks to investigate test-retest reliability. RESULTS Cronbach's α was 0.902 while the intraclass correlation coefficient (ICC) was 0.917. The standard error measurement (SEM) was seven points while the minimal detectable change with 95% confidence interval (MDC95) was seventeen points. The CPAQ-Ar showed moderate to high correlations with the PCS, the BDI-II, the SF-36, the MFIS, the PSQI, and the DASS-21 indicating a good concurrent validity. Exploratory factor analysis confirmed that the CPAQ-Ar consists of two subscales. Better pain acceptance associated with male gender, older people, employed participants, low pain intensity, and single pain site. CONCLUSIONS The CPAQ-Ar is a valid and reliable tool for the measurement of pain acceptance in Arabic speaking patients with CP.
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Affiliation(s)
- Safiah K Al-Arfaj
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Fuad A Abdulla
- Department of physical therapy, Faculty of Allied Medical Sciences, Philadelphia University, Amman, Jordan
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Crouch T, Sturgeon J, Guck A, Hagiwara N, Smith W, Trost Z. Race, Ethnicity, and Belief in a Just World: Implications for Chronic Pain Acceptance Among Individuals with Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:2309-2318. [PMID: 37454884 PMCID: PMC10789909 DOI: 10.1016/j.jpain.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Chronic pain acceptance is a psychological process consistently linked with improved functional outcomes. However, existing research on this construct has not considered the role of racial or ethnic background, despite growing evidence of racialized disparities in pain experience and treatment. This study aimed to examine racial differences in chronic pain acceptance, as measured by the chronic pain acceptance questionnaires (CPAQ), in a multicultural sample of individuals with chronic low back pain (N = 137-37.2% White, 31.4% Hispanic, and 31.4% Black/African American). We further sought to examine moderating effects of discrimination, pain-related perceived injustice (PI), and just world belief (JWB). Analyses consisted of cross-sectional one-way analyses of variance with Bonferroni-corrected post hoc comparisons, followed by regression models with interaction terms, main effects, and relevant covariates. Results indicated higher scores on the CPAQ for White individuals compared to Black or Hispanic individuals. Significant interactions were noted between race/ethnicity and JWB in predicting pain acceptance, after controlling for demographic and pain-related variables, such that the positive association between JWB and pain acceptance was significant for White participants only. Race/ethnicity did not show significant interactions with PI or prior racial discrimination. Findings highlight racial differences in levels of chronic pain acceptance, an adaptive pain coping response, and a stronger JWB appears to have a positive impact on pain acceptance for White individuals only. Results further confirm that members of disadvantaged racial groups may be more susceptible to poorer pain adjustment, which is the result of complex, multi-level factors. PERSPECTIVE: This study identifies racial differences in levels of pain acceptance, an adaptive psychological response to chronic pain, such that White individuals with chronic low back pain demonstrate higher levels of pain acceptance. The article further explores the impacts of intrapersonal and sociocultural variables on racial differences in pain acceptance.
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Affiliation(s)
- Taylor Crouch
- Department of Psychiatry, Virginia Commonwealth University, VA, USA
| | - John Sturgeon
- Department of Anaesthesiology, Michigan State University, MI, USA
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Ft. Worth, TX, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, VA, USA
| | - Wally Smith
- Department of Internal Medicine, Virginia Commonwealth University, VA, USA
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, VA, USA
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Buhrman M, Tillfors M, Holländare F, Lekström E, Håkansson A, Boersma K. Psychological Treatment Targeting Acceptance and Compassion in Patients With Chronic Pain: A Randomized Controlled, Internet-delivered, Treatment Trial. Clin J Pain 2023; 39:672-685. [PMID: 37712248 DOI: 10.1097/ajp.0000000000001157] [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: 09/14/2022] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing Acceptance and Commitment Therapy and compassion-focused therapy could improve psychological well-being and disability in individuals with chronic pain with high levels of self-criticism in comparison to a wait-list control group. METHODS Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were the Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were the Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory, and Perseverative Thinking Questionnaire. RESULTS Missing data at postintervention were 22.5%. Intention-to-treat analyses were conducted using linear mixed models. The results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large, and these results were maintained at 6-month follow-up. The rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favor of the treatment group. DISCUSSION Internet-based Acceptance and Commitment Therapy with compassion-focused therapy components shows promise as a viable treatment option in the management of chronic pain.
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Affiliation(s)
| | - Maria Tillfors
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad
| | | | | | | | - Katja Boersma
- School of Medical Sciences
- Center for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Kayacik Günday Ö, Harmanci H, Şenol Y. The Effect of Affective Temperament, Pain Catastrophizing, and Anxiety Sensitivity on Pain Severity in Patients With Chronic Pelvic Pain: A Pilot Study. J Psychiatr Pract 2023; 29:447-455. [PMID: 37801636 DOI: 10.1097/pra.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE The goals of this study were to investigate whether there was a dominant temperament type, and to assess the effect of temperament, pain catastrophizing, and anxiety sensitivity on pain severity, in female patients diagnosed with chronic pelvic pain (CPP) compared with healthy controls. METHODS This cross-sectional study involved 51 patients 18 to 65 years of age who were diagnosed with CPP without a history of psychiatric treatment and 97 healthy volunteer women with sociodemographic characteristics similar to those of the study group. A sociodemographic form prepared by the researchers, the Anxiety Sensitivity Index, the Pain Catastrophizing Scale, a temperament scale (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire), and a visual analog pain scale (VAS) were completed. The results were compared between the patient and control groups. Multiple regression analyses were performed to examine the predictive effects of temperament characteristics, pain catastrophizing, and anxiety sensitivity on pain severity. RESULTS Scores on the Pain Catastrophizing Scale and the VAS were statistically significantly higher in the CPP group ( P <0.001). The frequency of depressive, cyclothymic, and irritable temperaments was found to be significantly higher in the CPP group (CPP: 7.78±3.32 vs. controls: 6.54±3.19; P =0.027; CPP:10.61±4.41 vs. controls: 8.82±4.21; P =0.017; CPP: 5.22±4.29 vs. controls: 3.75±3.41; P =0.025). According to the model established by temperament traits, anxiety sensitivity, and pain catastrophizing level, pain catastrophizing level explained 11.6% of the variance in pain severity. A 1-unit change in the score for pain catastrophizing level caused a 0.278-point change in the VAS total score ( P <0.01). CONCLUSIONS Cyclothymic, depressive, and irritable temperament types that increase the risk of affective disease are more common in patients with CPP. The level of pain catastrophizing in patients with CPP affects their perception of the severity of the pain.
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Polk AN, Smitherman TA. A meta-analytic review of acceptance-based interventions for migraine. Headache 2023; 63:1271-1284. [PMID: 37635382 DOI: 10.1111/head.14614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To determine the efficacy of acceptance and mindfulness-based interventions on migraine disability, medication use, and attack frequency. BACKGROUND Acceptance-based approaches to headache management are those in which individuals learn to mitigate the influence of pain-related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness-based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance-based interventions for headache broadly and migraine specifically, no meta-analytic review of ACT interventions for headache exists, and two meta-analytic reviews of mindfulness-based practices yielded conflicting results. METHODS The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance-based interventions among adults with migraine. A multi-database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness-based interventions to control treatment. Random-effects meta-analyses were performed using RevMan 5.4 meta-analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I2 index and explored via subgroup analyses. RESULTS Acceptance-based interventions yielded significant improvements in disability (SMD = -0.38, 95% CI = -0.56 to -0.20; I2 = 25%, p = 0.20) but not in medication use (SMD = -0.25, 95% CI: -0.57 to 0.06; I2 = 0%, p = 0.82) or headache frequency (SMD = -0.16, 95% CI = -0.37 to 0.05; I2 = 0%, p = 0.73). CONCLUSION Results suggest that acceptance-based interventions are effective in improving disability among adults with migraine and are a viable non-pharmacological treatment option, in addition to well-established behavioral migraine management approaches, for patients seeking functional improvement.
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Affiliation(s)
- Ashley N Polk
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
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Gerdle B, Dragioti E, Rivano Fischer M, Dong HJ, Ringqvist Å. Catastrophizing and acceptance are mediators between insomnia and pain intensity-an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions. FRONTIERS IN PAIN RESEARCH 2023; 4:1244606. [PMID: 37828972 PMCID: PMC10565667 DOI: 10.3389/fpain.2023.1244606] [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: 06/23/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Background Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship. Aims In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators. Methods This study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008-2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline. Results In this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia-pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths. Discussion and conclusion This study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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Karayannis NV, Sturgeon JA, Kemani MK, Mackey SC, Greco CM, Wicksell RK, McCracken LM. Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology. Scand J Pain 2023; 23:464-475. [PMID: 36745187 PMCID: PMC10522049 DOI: 10.1515/sjpain-2022-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/14/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference. METHODS Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth modelling to analyze scores assessed within 180 days of patient care. RESULTS Psychological inflexibility (PIPS-12) and pain acceptance (CPAQ-8) measured at baseline predicted PI outcomes (n=86). PIPS-12 showed a direct relationship with pain interference (PI), where higher PIPS-12 scores predicted significantly higher PI mean scores on average across the study period (ρ=0.422, r2=0.382) but also predicted significantly greater decreases in PI across time (ρ=-0.489, r2=0.123). Higher CPAQ-8 scores predicted significantly lower PI mean scores on average across the study period (ρ=-0.478, r2=0.453) but also significantly smaller decreases in PI across time (ρ=0.495, r2=0.076). Awareness (FFMQ-SF) and engagement (CAQ-8) were not predictive of PI outcomes. CONCLUSIONS Patients who entered pain psychology treatment with lower pain acceptance and higher psychological inflexibility showed the largest reductions in pain interference across time. These results contribute towards a novel prognostic understanding of the predictive roles of an enhancing dimension and limiting dimension of psychological flexibility.
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Affiliation(s)
| | - John A Sturgeon
- Department of Psychology, University of Washington, Seattle, USA
| | - Mike K Kemani
- Medical Unit Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Sean C Mackey
- Division of Pain Medicine, Stanford University, Stanford, USA
| | - Carol M Greco
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Solna, Sweden
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12
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Wang Y, Chen T. Perceived Control, Control Strategies, and Subjective Well-being in the Elderly: A Longitudinal Study of Health Behavior. Am J Health Behav 2023; 47:549-557. [PMID: 37596744 DOI: 10.5993/ajhb.47.3.12] [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: 08/20/2023]
Abstract
Objectives: We analyzed the directional effect of perceived control and control strategies on subjective well-being in middle-aged and elderly people with historical data, and to provide data support for the intervention of well-being in the later years of the elderly group, so as to help them age successfully.Methods: Using data from the CLHLS between 2005 and 2014, we collected demographic and social data of the same elderly population over the decade. We also gathered information on changes in well-being, perceived control, and the use of control strategies. To analyze the longitudinal relationship between subjective well-being and perceived control, including the impact of control strategies on subjective well-being, we used a multilevel growth model with MPLUS. Results: We found that subjective well-being and perceived control were not affected by time. However, changes in perceived control in older adults could predict their level of subjective well-being. Those with higher initial levels of perceived control experienced greater increases in subjective well-being. Additionally, the use of control strategies had a significant influence on changes in subjective well-being, explaining 70.5% of the variance. Conclusion: Combined use of multiple control strategies is a feasible way to improve subjective well-being in later life.
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Affiliation(s)
- Yiyin Wang
- Institute of Psychology, Chinese Academy of Sciences, and Department of Psychology, University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Tianyong Chen
- Institute of Psychology, Chinese Academy of Sciences, and Department of Psychology, University of Chinese Academy of Sciences, Beijing, P.R. China
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13
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Beiranvand S, Ashrafizadeh H, Sheini-Jaberi P. Investigating the Relationship between Empowerment and Chronic Pain Acceptance and the Resulting Limitations in the Elderly with Diabetes living Southwest of Iran. Pain Manag Nurs 2023; 24:130-137. [PMID: 36604195 DOI: 10.1016/j.pmn.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/23/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AIM Considering the importance of pain acceptance in adjusting to chronic pain among diabetic patients, this study was conducted to determine the relationship between the empowerment scale and the level of chronic pain acceptance among the elderly with diabetes and the resulting limitations. METHOD This is a descriptive-analytical study on 250 older patients (65 years and older) with diabetes. The samples were selected through random convenience sampling, performed during 2019 to 2020 in the health centers of Ahvaz, Iran. The data were collected using the demographic information checklist and standard questionnaires including chronic pain acceptance questionnaire (CPAQ), the scale of chronic pain-related limitations, and the diabetes empowerment scale-short form (DES-SF). The data were analyzed using SPSS V24. RESULTS The majority of the samples were male (56%) and the mean age of the participants was 70.96 ± 8.95 years. The results showed that the mean and standard deviation were reported to be 20.04 ± 4.63 for pain acceptance, 46.16 ± 10.85 for chronic pain-related limitations, and 27.24 ± 9.65 for the empowerment scale. According to regression coefficients, the mean score of empowerments of patients with diabetes has no significant relationship with pain acceptance (p = .199, b = -0.327) and pain-related limitations (p = .925, b = 0.004). CONCLUSIONS Based on the results of this study, the level of empowerment, pain acceptance, and pain-related limitations in the older patients with diabetes was moderate and there was no significant relationship between them. Identifying vulnerable groups in the field of chronic pain and preventive, educational and therapeutic interventions will help increase patients' self-care capacity and reduce the limitations and the disability caused by pain.
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Affiliation(s)
- Samira Beiranvand
- Nursing Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hadis Ashrafizadeh
- Nursing Department, School of Nursing, Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran
| | - Parisa Sheini-Jaberi
- Nursing Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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14
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Sanmugananthan VV, Cheng JC, Hemington KS, Rogachov A, Osborne NR, Bosma RL, Kim JA, Inman RD, Davis KD. Can we characterize A-P/IAP behavioural phenotypes in people with chronic pain? FRONTIERS IN PAIN RESEARCH 2023; 4:1057659. [PMID: 36874441 PMCID: PMC9975728 DOI: 10.3389/fpain.2023.1057659] [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: 09/29/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
Two behavioural phenotypes in healthy people have been delineated based on their intrinsic attention to pain (IAP) and whether their reaction times (RT) during a cognitively-demanding task are slower (P-type) or faster (A-type) during experimental pain. These behavioural phenotypes were not previously studied in chronic pain populations to avoid using experimental pain in a chronic pain context. Since pain rumination (PR) may serve as a supplement to IAP without needing noxious stimuli, we attempted to delineate A-P/IAP behavioural phenotypes in people with chronic pain and determined if PR can supplement IAP. Behavioural data acquired in 43 healthy controls (HCs) and 43 age-/sex-matched people with chronic pain associated with ankylosing spondylitis (AS) was retrospectively analyzed. A-P behavioural phenotypes were based on RT differences between pain and no-pain trials of a numeric interference task. IAP was quantified based on scores representing reported attention towards or mind-wandering away from experimental pain. PR was quantified using the pain catastrophizing scale, rumination subscale. The variability in RT was higher during no-pain trials in the AS group than HCs but was not significantly different in pain trials. There were no group differences in task RTs in no-pain and pain trials, IAP or PR scores. IAP and PR scores were marginally significantly positively correlated in the AS group. RT differences and variability were not significantly correlated with IAP or PR scores. Thus, we propose that experimental pain in the A-P/IAP protocols can confound testing in chronic pain populations, but that PR could be a supplement to IAP to quantify attention to pain.
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Affiliation(s)
- Vaidhehi Veena Sanmugananthan
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua C Cheng
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kasey S Hemington
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Anton Rogachov
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Natalie Rae Osborne
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Rachael L Bosma
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Junseok Andrew Kim
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Robert D Inman
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen Deborah Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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15
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Pinto CB, Bielefeld J, Barroso J, Yip B, Huang L, Schnitzer T, Apkarian AV. Chronic pain domains and their relationship to personality, abilities, and brain networks. Pain 2023; 164:59-71. [PMID: 35612403 PMCID: PMC9582040 DOI: 10.1097/j.pain.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/23/2022] [Indexed: 01/09/2023]
Abstract
Abstract
Chronic pain is a multidimensional pathological state. Recent evidence suggests that specific brain properties and patients' psychological and physical traits are distorted in chronic pain patients. However, the relationship between these alterations and pain dimensions remains poorly understood. Here, we first evaluated multiple dimensions of chronic pain by assessing a broad battery of pain-related questionnaire scores (23 outcomes) of 107 chronic low back pain patients and identified 3 distinct chronic pain domains: magnitude, affect & disability, and quality. Second, we investigated the pain domains relationship with measures of personality, social interaction, psychological traits, and ability traits (77 biopsychosocial & ability [biopsy&ab] outcomes). Pain magnitude (out-of-sample [OOS]
) is associated with emotional control, attention, and working memory, with higher pain scores showing lower capacity to regulate and adapt behaviorally. Pain affect & disability (OOS
associated with anxiety, catastrophizing and social relationships dysfunction. Pain quality did not relate significantly to biopsy&ab variables. Third, we mapped these 3 pain domains to brain functional connectivity. Pain magnitude mainly associated with the sensorimotor and the cingulo-opercular networks (OOS
). Pain affect & disability related to frontoparietal and default mode networks (OOS
. Pain quality integrated sensorimotor, auditory, and cingulo-opercular networks (OOS
). Mediation analysis could link functional connectivity and biopsy&ab models to respective pain domains. Our results provide a global overview of the complexity of chronic pain, showing how underlying distinct domains of the experience map to different biopsy&ab correlates and underlie unique brain network signatures.
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Affiliation(s)
- Camila Bonin Pinto
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jannis Bielefeld
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joana Barroso
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Byron Yip
- Departments of Physical Medicine and Rehabilitation
| | - Lejian Huang
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Thomas Schnitzer
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
- Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - A Vania Apkarian
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Departments of Physical Medicine and Rehabilitation
- Anesthesiology, and
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16
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Jotwani ML, Wu Z, Lunde CE, Sieberg CB. The missing mechanistic link: Improving behavioral treatment efficacy for pediatric chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1022699. [PMID: 36313218 PMCID: PMC9614027 DOI: 10.3389/fpain.2022.1022699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
Pediatric chronic pain is a significant global issue, with biopsychosocial factors contributing to the complexity of the condition. Studies have explored behavioral treatments for pediatric chronic pain, but these treatments have mixed efficacy for improving functional and psychological outcomes. Furthermore, the literature lacks an understanding of the biobehavioral mechanisms contributing to pediatric chronic pain treatment response. In this mini review, we focus on how neuroimaging has been used to identify biobehavioral mechanisms of different conditions and how this modality can be used in mechanistic clinical trials to identify markers of treatment response for pediatric chronic pain. We propose that mechanistic clinical trials, utilizing neuroimaging, are warranted to investigate how to optimize the efficacy of behavioral treatments for pediatric chronic pain patients across pain types and ages.
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Affiliation(s)
- Maya L. Jotwani
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Ziyan Wu
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Claire E. Lunde
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Christine B. Sieberg
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States,Correspondence: Christine B. Sieberg
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17
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Kreher DA, Li R, Gubbels AL. Pain acceptance predicts healthcare utilization in women with chronic pelvic pain. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2022. [DOI: 10.1177/22840265221114312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Chronic pelvic pain (CPP) in women is common and costly, and little is known about patient characteristics predicting healthcare utilization within this population. The present study examined the role of pain acceptance and pain catastrophizing, assessed prior to treatment initiation, in predicting future uptake of medical and surgical interventions specifically for pain management. Methods: Our sample comprised women referred to a tertiary gynecological center. Baseline pain catastrophizing and pain acceptance scores were compared across each major medication class and surgery type, as well as across the total number of medication classes and the total number of surgery types using analysis of variance (ANOVA). We then performed multivariable analyses for the association between pain catastrophizing and pain acceptance and treatment utilization by controlling for potential confounders. Results: Three hundred eighteen patients met inclusion criteria. Pain catastrophizing was associated with increased likelihood of neuromodulator prescription, while pain acceptance was associated with reduced likelihood of neuromodulator prescription and fewer medication classes prescribed. Overall, no associations between pain catastrophizing and surgeries were observed, while pain acceptance was significantly associated with lower risk of hysterectomy/oophorectomy. Conclusion: Pain acceptance was a robust predictor of number of medication classes prescribed and use of radical surgeries even when controlling stringently for confounders. It is worth considering routine assessment of pain acceptance early in treatment of CPP to identify those more at-risk of higher treatment utilization, and potentially mitigate this through engagement with appropriate behavioral therapies.
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Affiliation(s)
- Donna A Kreher
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Rui Li
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute Seattle, Seattle, WA, USA
| | - Ashley L Gubbels
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Phoenix, AZ, USA
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18
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Andreucci A, Roos EM, Rasmussen S, Olesen JL, Hölmich P, Thorborg K, Rathleff MS. Analgesic use in adolescents with patellofemoral pain or Osgood-Schlatter Disease: a secondary cross-sectional analysis of 323 subjects. Scand J Pain 2022; 22:543-551. [PMID: 34860477 DOI: 10.1515/sjpain-2021-0121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/22/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The prevalence of pain medication use for adolescent knee pain and factors associated with use are not well understood. This study aimed to determine the self-reported use of pain medication for knee pain and identify factors associated with use in adolescents (age 10-19) with longstanding knee symptoms. METHODS In this exploratory cross-sectional study, we performed a secondary analysis of data previously collected in 323 adolescents with longstanding knee pain. Factors associated with pain medication use were assessed using multivariable logistic regressions. Analyses were repeated with stratification by age, sex, sport participation frequency, knee pain duration, and knee pain intensity. RESULTS Among 323 adolescents (mean age 14.4 ± 2.5, 73% female), 84% had patellofemoral pain, (peri- or retro-patellar pain during loaded bending of the knee) and 16% had Osgood-Schlatter Disease (apophysitis with swelling and localized pain at the tibial tuberosity). Twenty-one percent (95% CI 16-25%) of adolescents reported pain medication use for their knee pain, with no difference in usage between those ≤ vs. > 15 years of age (21%, 95% CI 16-27% vs. 20%, 95% CI 13-29%). Adolescents with patellofemoral pain reported greater usage than their counterparts with Osgood-Schlatter Disease (22%, 95% CI 17-28% vs. 12%, 95% CI 4.5-24.3%). The most consistent factor associated with use was knee-related symptoms, observed in both the overall (OR 0.97, 95% CI 0.94-0.99) and stratified analyses (ORs ranged from 0.89 to 0.96). CONCLUSIONS Approximately one in five adolescents with longstanding knee pain reported pain medication use, particularly in adolescents with patellofemoral pain. Knee-related symptoms most consistently associated with the use of pain medications in this population. Future longitudinal studies with data collected at multiple time-points are needed to validate these findings. IMPLICATIONS Self-reported pain medication use is common in adolescents with longstanding knee pain, even though whether pharmacological therapy is the best pain management option at this young age is debatable. Reliance on pain medication at an early age could potentially hamper the development of healthy pain coping strategies and increase the risk of dependence and misuse later in life. Future studies should assess the safety, efficacy, and risks of long-term use of pain medications for adolescent knee pain.
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Affiliation(s)
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Sten Rasmussen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jens L Olesen
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Hvidovre, Denmark
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Hvidovre, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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19
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Bernini O, Tumminaro G, Compare L, Belviso C, Conforti V, Berrocal Montiel C. Incremental validity of acceptance over coping in predicting adjustment to endometriosis. FRONTIERS IN PAIN RESEARCH 2022; 3:928985. [PMID: 35910263 PMCID: PMC9335002 DOI: 10.3389/fpain.2022.928985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Psychological acceptance has emerged as an important construct to explain low psychological distress in different clinical samples. However, the incremental validity of psychological acceptance to explain adjustment to medical conditions over other related and well-established constructs, such as coping, is relatively unclear. This study explored whether psychological acceptance significantly contributes to explain adjustment above and beyond coping in females with endometriosis. A total of 169 females (Mage = 34.95 years; SDage = 6.07 years) with endometriosis and pain symptoms completed the Acceptance and Action Questionnaire-II, the Brief-COPE, the Hospital Anxiety and Depression Scale, the Psychological Wellbeing Scale, and the Endometriosis Health Profile-5. We conducted Hierarchical Regression Analyses to determine the contribution of psychological acceptance to explaining adjustment. The results showed that the contribution of psychological acceptance ranged from 11 to 20% when controlling for coping, while coping explained from 1 to 8% when the model was reversed. The findings suggest that psychological acceptance is a more useful construct than coping for predicting PD and other psychological outcomes in females with endometriosis.
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Affiliation(s)
- Olivia Bernini
- University Counseling Services, University of Pisa, Pisa, Italy
| | - Giovanni Tumminaro
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Lisa Compare
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | | | - Valentina Conforti
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Carmen Berrocal Montiel
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
- *Correspondence: Carmen Berrocal Montiel
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20
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Gasslander N, Andersson G, Boström F, Brandelius L, Pelling L, Hamrin L, Gordh T, Buhrman M. Tailored internet-based cognitive behavioral therapy for individuals with chronic pain and comorbid psychological distress: a randomized controlled trial. Cogn Behav Ther 2022; 51:408-434. [PMID: 35533363 DOI: 10.1080/16506073.2022.2065528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Comorbid psychological problems are commonly related to chronic pain but addressing heterogeneous comorbidities in traditional settings is often difficult. Delivering individually tailored treatment using the internet could be a viable alternative. The present study investigates whether a guided, individually tailored and internet-delivered cognitive behavioral therapy (ICBT) could improve mood and reduce disability in individuals suffering from chronic pain and comorbid psychological distress.Participants were recruited from a pain clinic and randomized to either ICBT or waiting list. The participants (n = 187) individually tailored treatments included 6-13 modules targeting different types of psychological distress. Modules were designed to be completed weekly, and feedback was provided by clinicians. Participants completed an average of 5.1 (49.7%) modules, with 22.9% completing all assigned modules. Intention-to-treat analyses showed significantly larger improvements in depression, disability, pain acceptance, catastrophizing, and quality of life in the ICBT-group compared to the control group. Between-group effect sizes were very small or small at post for the primary outcomes depression (d = 0.18) and pain interference (d = 0.22). Other effect sizes ranged from very small to small, with the largest effect being improvements in pain acceptance (d = 0.3). All significant changes were stable at 12-month follow up.
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Affiliation(s)
- Nils Gasslander
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frida Boström
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lisa Brandelius
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lotta Pelling
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lovisa Hamrin
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Pain Research, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
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21
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Mahmoud Alilou M, Pak R, Mahmoud Alilou A. The Mediating Role of Coping Strategies and Emotion Regulation in the Relationship Between Pain Acceptance and Pain-Related Anxiety. J Clin Psychol Med Settings 2022; 29:977-990. [DOI: 10.1007/s10880-022-09863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
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22
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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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Jäger M, Terry J, Rance J. ‘A Mindful ACT’- testing the feasibility and acceptability of a brief psychosocial intervention designed to accompany Osteopathy treatment for people who live with persistent pain. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tangen SF, Helvik AS, Eide H, Fors EA. Pain acceptance and its impact on function and symptoms in fibromyalgia. Scand J Pain 2021; 20:727-736. [PMID: 32759409 DOI: 10.1515/sjpain-2020-0049] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/17/2020] [Indexed: 12/30/2022]
Abstract
Objectives Fibromyalgia is a chronic widespread pain (CWP) syndrome of unknown etiology with substantial burden of illness and functional impairment. Pain acceptance has emerged as an interesting target of therapy in chronic pain populations, but few studies have yet been done on the effect of pain acceptance on patients with fibromyalgia. The aim of the present study was to examine the relationship between pain acceptance and its impact on function and symptoms in fibromyalgia with both a cross-sectional and longitudinal design. Methods Three hundred and sixty five participants aged 22-70 with fibromyalgia were recruited from the Norwegian Fibromyalgia Association (NFA). They filled out a questionnaire containing the Fibromyalgia Impact Questionnaire (FIQ), measurement of function and symptoms, and Chronic Pain Acceptance Questionnaire (CPAQ), measurement of pain acceptance, in addition to sociodemographic and clinical variables such as degree of fibromyalgia, depression and pain duration (T1 measures). One year after, 87 of the participants filled out the FIQ and clinical measures once again (T2 measures). Unadjusted and adjusted linear regression analyses were performed both for cross-sectional measures at T1 and for longitudinal measures from T1 to T2, with FIQ score as the outcome variable and CPAQ score at T1 as one of the main independent variables. Results Higher CPAQ score was significantly associated with a lower FIQ score at T1, also when adjusting for age, education, work, depression and Fibromyalgianess Score (p<0.01). Lower FIQ score indicate less impact of fibromyalgia on functioning. In addition, two adjusted linear regression models found higher pain acceptance (CPAQ score) at T1 to be associated with lower negative impact of fibromyalgia on function and symptoms (FIQ score) at T2 (p<0.01). Conclusions Higher pain acceptance is associated with better functional level and less symptoms in fibromyalgia, both cross-sectionally and when measurements are separated in time. Further research should include experimental studies with acceptance-based interventions for this patient group.
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Affiliation(s)
- Synne Flatlandsmo Tangen
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, General Practitioner Research Unit, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne-Sofie Helvik
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, General Practitioner Research Unit, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Egil A Fors
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, General Practitioner Research Unit, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Vendrusculo-Fangel LM, Fangel R, Vieira de Sousa Neto I, Nobrega OT, Dos Reis FJJ, Durigan JLQ, de Cassia Marqueti R. Structural equation modelling provides insights to understand the construct of chronic pain in women with rheumatoid arthritis. Mod Rheumatol 2021; 32:554-564. [PMID: 34897496 DOI: 10.1093/mr/roab027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We aimed to adopt a multidimensional approach and investigate the interconnections between biomarkers (cytokines, matrix metalloproteinases, and cortisol) and psychosocial aspects considering pain acceptance, the individual construct of pain perception in terms of blood inflammation biomarkers, anxiety, self-efficacy, and functional performance and to define the quality of life (QoL) in women with rheumatoid arthritis (RA). METHODS An observational cross-sectional study with a total of 42-RA participants, with chronic pain and 42-women without rheumatic diseases or chronic pain were included. A structural equation model was used to investigate the association between independent variables. RESULTS Women with RA presented high blood biomarker levels, representing an intense inflammatory process. The participants with RA reported moderate pain most of the time, a worsening QoL, functionality, engagement in activities, and a willingness to live with pain and self-efficacy. It was found that the higher the chronic pain, the greater the intensity of pain perceived by these women with RA, as well as, the worse the functionality, the higher the perceived pain. CONCLUSIONS The exacerbation of pain perception leads to worsening of the experience of chronic pain. The new construct of pain experience should include functionality as a crucial factor in understanding the mechanisms underlying pain.
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Affiliation(s)
- Leticia Meda Vendrusculo-Fangel
- Graduate Program of Sciences and Technology of Health and Rehabilitation Sciences, Faculty of Ceilândia, University of Brasilia, Distrito Federal, Brazil.,Occupational therapy professor, University of Brasilia, Distrito Federal, Brazil
| | - Renan Fangel
- Graduate Program of Sciences and Technology of Health and Rehabilitation Sciences, Faculty of Ceilândia, University of Brasilia, Distrito Federal, Brazil.,Physical Therapy Department, Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivo Vieira de Sousa Neto
- Graduate Program of Sciences and Technology of Health and Rehabilitation Sciences, Faculty of Ceilândia, University of Brasilia, Distrito Federal, Brazil
| | - Otavio Toledo Nobrega
- Division of Geriatric Medicine, Faculty of Medicine, McGill University Health Center (MUHC), Glen site, 1001 Boul. Décarie, Montreal, QC, Canada
| | - Felipe José Jandre Dos Reis
- Physical Therapy Departament, Euro-American University Center Distrito Federa, Brazil.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - João Luiz Quaglioti Durigan
- Graduate Program of Sciences and Technology of Health and Rehabilitation Sciences, Faculty of Ceilândia, University of Brasilia, Distrito Federal, Brazil.,Graduate Program of Rehabilitation Sciences, Faculty of Ceilândia, University of Brasilia, Distrito Federal, Brazil
| | - Rita de Cassia Marqueti
- Graduate Program of Sciences and Technology of Health and Rehabilitation Sciences, Faculty of Ceilândia, University of Brasilia, Distrito Federal, Brazil.,Graduate Program of Rehabilitation Sciences, Faculty of Ceilândia, University of Brasilia, Distrito Federal, Brazil
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Shanahan ML, Fischer IC, Hirsh AT, Stewart JC, Rand KL. Hope, Optimism, and Clinical Pain: A Meta-Analysis. Ann Behav Med 2021; 55:815-832. [PMID: 33580660 DOI: 10.1093/abm/kaab001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Generalized expectancies have been theorized to play key roles in pain-related outcomes, but the empirical findings have been mixed. PURPOSE The primary aim of this meta-analysis was to quantify the relationships between two of the most researched positive generalized expectancies (i.e., hope and optimism) and pain-related outcomes (i.e., pain severity, physical functioning, and psychological dysfunction) for those experiencing clinical pain. METHODS A total of 96 studies and 31,780 participants with a broad array of pain diagnoses were included in analyses, using random-effects models. RESULTS Both hope and optimism had negative correlations with pain severity (hope: r = -.168, p < .001; optimism: r = -.157, p < .001), positive correlations with physical functioning (hope: r = .199, p < .001; optimism: r = .175, p < .001), and negative correlations with psychological dysfunction (hope: r = -.349, p = .001; optimism: r = -.430, p <.001). CONCLUSION The current findings suggest that hope and optimism are similarly associated with adaptive pain-related outcomes. Future research should examine the efficacy of interventions on hope and optimism in ameliorating the experience of clinical pain.
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Affiliation(s)
- Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Ian C Fischer
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Daffin M, Lynch-Milder MK, Gibler RC, Murray C, Green CM, Kashikar-Zuck S. A qualitative study of risk and resilience in young adult women with a history of juvenile-onset fibromyalgia. Pediatr Rheumatol Online J 2021; 19:128. [PMID: 34404452 PMCID: PMC8371844 DOI: 10.1186/s12969-021-00628-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Juvenile-onset Fibromyalgia (JFM) is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep difficulties, mood concerns, and other associated symptoms. Although diagnosed in childhood, JFM often persists into adulthood can result in continued physical, social, and psychological impairment. The purpose of this qualitative study was to identify themes of risk and resilience for long-term outcomes among young adults diagnosed with JFM in childhood. METHODS The sample included 13 young adults (ages 26-34) who had been diagnosed with JFM in adolescence. Focus groups were used to elicit qualitative information about living with JFM and perceived challenges and buffering factors impacting their adjustment. RESULTS The majority of participants (80%, N = 12) continued to meet criteria for fibromyalgia (FM). An iterative, thematic analysis revealed themes of resilience (e.g., greater acceptance, re-setting expectations, active coping, addressing mental health) and risk (e.g., lack of information, stigma, isolation, negative healthcare experiences). CONCLUSION Results suggest the need for longer follow-up of youth with JFM as they transition to adulthood with multidisciplinary care and more attention to education about JFM and associated symptoms such as fatigue, as well as ongoing support for coping and mental health needs. A holistic approach to care during the transition years could be beneficial to minimize impact of JFM on long-term functioning.
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Affiliation(s)
- Morgan Daffin
- Department of Pediatrics, Division of Child & Adolescent Psychiatry and Psychology, Norton Children's Medical Group, University of Louisville School of Medicine, 200 East Chestnut Street, Louisville, KY, 40202, USA.
| | - Mary K Lynch-Milder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
| | - Robert C Gibler
- Department of Psychology, University of Cincinnati, Cincinnati, USA
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Caitlin Murray
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, USA
| | - Carly M Green
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
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Pain Acceptance Creates an Emotional Context That Protects against the Misuse of Prescription Opioids: A Study in a Sample of Patients with Chronic Noncancer Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063054. [PMID: 33809628 PMCID: PMC8002364 DOI: 10.3390/ijerph18063054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 02/05/2023]
Abstract
There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical model in which pain acceptance would regulate pain sensations and pain-related thoughts and emotions, which would be related to opioid misuse. The sample comprised 140 chronic pain patients attending two hospitals. All patients were receiving pharmacological treatment, including opioid analgesics. Structural equation modelling analyses showed a significant association between higher pain acceptance and lower pain intensity and catastrophizing, and lower levels of anxiety and depression. Only higher anxiety and depression were significantly associated with increased opioid misuse. The results suggest that levels of anxiety, depression, and pain acceptance must be assessed before opioids are prescribed. Pain acceptance implies a relationship with internal events that protects against anxiety and depression and thus against opioid misuse. Acceptance and Commitment Therapy appears to be particularly appropriate for these patients.
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Titze C, Hasenbring MI, Kristensen L, Bendix L, Vaegter HB. Patterns of Approach to Activity in 851 Patients With Severe Chronic Pain: Translation and Preliminary Validation of the 9-item Avoidance-Endurance Fast-Screen (AEFS) Into Danish. Clin J Pain 2021; 37:226-236. [PMID: 33399395 DOI: 10.1097/ajp.0000000000000912] [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: 03/06/2020] [Accepted: 12/12/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The Avoidance-Endurance Fast-Screen (AEFS) is a 9-item self-report questionnaire that classifies patients with back pain into 4 activity-related subgroups, based on the Avoidance-Endurance Model of pain. The objective of this study was to translate the AEFS into Danish and investigate its discriminative abilities in a large, diverse patient sample. MATERIALS AND METHODS A total of 851 specialist care-seeking patients with severe chronic pain conditions participated in this cross-sectional study. Participants were categorized as showing a "distress-endurance" (DER), "eustress-endurance" (EER), "fear-avoidance" (FAR), or "adaptive" (AR) pattern. Principal component analysis reduced a large number of psychological variables beforehand. Construct and outcome-based validity were explored using multivariate analysis of variance. RESULTS Of the participants, 33.6% were categorized as DER, 29.4% as EER, 22% as FAR, and 15% as adaptive. Principal component analysis showed the factors activity-related pain behavior, affective distress, and dysfunctional pain thoughts. The AEFS-DK discriminated all 4 subgroups in terms or their pain behavior with EER>DER>AR>FAR. FAR showed less moderate/vigorous activity than DER and EER and more sedentary time than EER. DER and FAR showed higher affective distress, dysfunctional pain thoughts, and poorer outcomes than AR and EER. CONCLUSION The results indicate good construct validity of the AEFS-DK discriminating the 4 avoidance-endurance model-related subgroups with respect to approach to activity behavior, psychological variables, and reported physical activity. Concerning outcome-based validity, 2 subgroups DER/FAR and AR/EER could be distinguished with inconclusive results for the eustress-endurance subgroup. Future studies are warranted using longitudinal research designs investigating whether AEFS subgroups differ in terms of treatment effects and long-term prognosis.
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Affiliation(s)
- Christina Titze
- Department of Medical Psychology and Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Monika I Hasenbring
- Department of Medical Psychology and Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | | | - Laila Bendix
- Pain Research Group, Pain Center, Odense University Hospital
| | - Henrik B Vaegter
- Pain Research Group, Pain Center, Odense University Hospital
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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30
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Torrijos‐Zarcero M, Mediavilla R, Rodríguez‐Vega B, Del Río‐Diéguez M, López‐Álvarez I, Rocamora‐González C, Palao‐Tarrero Á. Mindful Self‐Compassion program for chronic pain patients: A randomized controlled trial. Eur J Pain 2021; 25:930-944. [DOI: 10.1002/ejp.1734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/29/2020] [Accepted: 01/16/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Marta Torrijos‐Zarcero
- Psychiatry, Clinical Psychology and Mental Health Department La Paz University Hospital Madrid Spain
- La Paz Hospital Institute for Health Research (IdiPAZ) Madrid Spain
| | | | - Beatriz Rodríguez‐Vega
- Psychiatry, Clinical Psychology and Mental Health Department La Paz University Hospital Madrid Spain
- La Paz Hospital Institute for Health Research (IdiPAZ) Madrid Spain
- Autonomous University of Madrid (UAM) Madrid Spain
| | | | - Inés López‐Álvarez
- Psychiatry, Clinical Psychology and Mental Health Department La Paz University Hospital Madrid Spain
- La Paz Hospital Institute for Health Research (IdiPAZ) Madrid Spain
| | - Cristina Rocamora‐González
- Psychiatry, Clinical Psychology and Mental Health Department La Paz University Hospital Madrid Spain
- La Paz Hospital Institute for Health Research (IdiPAZ) Madrid Spain
| | - Ángela Palao‐Tarrero
- Psychiatry, Clinical Psychology and Mental Health Department La Paz University Hospital Madrid Spain
- La Paz Hospital Institute for Health Research (IdiPAZ) Madrid Spain
- Autonomous University of Madrid (UAM) Madrid Spain
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Hwang BY, Negoita S, Duy PQ, Tesay Y, Anderson WS. Opioid use and spinal cord stimulation therapy: The long game. J Clin Neurosci 2021; 84:50-52. [PMID: 33485599 DOI: 10.1016/j.jocn.2020.12.004] [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] [Received: 09/16/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Spinal cord stimulation (SCS) has been considered as an alternative therapy to reduce opioid requirements in certain chronic pain disorders. However, information on long-term opioid consumption patterns and their impact on SCS device explantation is lacking. We conducted a retrospective study of 45 patients to characterize long-term patterns of opioid usage after SCS implantation. Daily morphine equivalent dosage (MED) increased, decreased, and remained the same in 40%, 40%, and 20% of patients at 1-year follow-up, respectively. Twelve (27%) underwent explantation due to treatment failure at a median of 18 months after implantation. Pre-operative opioid status (naïve vs. active use) was not associated with explantation (18% vs. 29%, p = 0.699) and neither was the daily MED change status (i.e. increased, decreased, unchanged) at 1-year (p = 0.499, 1.000, 0.735, respectively). Following explantation, reduction in the daily MED was seen in 92% of patients with dosages falling below pre-operative baseline in nine. Among the opioid naïve patients, 55% were on opioids at last follow-up (average 32.4 ± 14.6 months). Our results indicate that daily opioid consumption does not decrease in most patients 1-year after SCS implantation. Furthermore, post-operative evaluation beyond 1-year is necessary to assess the efficacy and durability of SCS therapy as well as its impact on opioid requirement. Lastly, rigorous patient selection and pre-operative risk assessment for misuse and dependence are paramount to improving outcome after SCS implantation.
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Affiliation(s)
- Brian Y Hwang
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Serban Negoita
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phan Q Duy
- Medical Scientist Training Program, Yale University School of Medicine, New Haven, CT, USA
| | - Yohannes Tesay
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William S Anderson
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chana P, Smith JG, Karamat A, Simpson A, Renton T. Catastrophising, pain self-efficacy and acceptance in patients with Burning Mouth Syndrome. J Oral Rehabil 2021; 48:458-468. [PMID: 33368621 DOI: 10.1111/joor.13136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/13/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known about pain catastrophising, pain self-efficacy and chronic pain acceptance in burning mouth syndrome (BMS) and their effect on health-related quality of life (HRQoL) and symptoms of anxiety and depressive disorders. OBJECTIVES To describe pain catastrophising, pain self-efficacy and pain acceptance in BMS patients and explore associations with affective function and HRQoL. METHODS A cross-sectional study of 36 BMS patients (31 female) referred to an Orofacial Pain Clinic completed the Pain Catastrophizing Scale, the Pain Self-Efficacy Questionnaire and the Chronic Pain Acceptance Questionnaire-8 in addition to standardised self-reported questionnaires measuring mood and oral and generic HRQoL. RESULTS Pain catastrophising levels were markedly higher than (non-clinical) population norms, with 32.0% of patients reporting clinically relevant levels. Pain self-efficacy and chronic pain acceptance varied widely; 24.0% evidenced low confidence to cope with pain, and 53.8% reported low activity engagement and/or low pain willingness. Catastrophising showed moderate-to-strong associations with measures of anxiety (r = 0.63), depression (r = 0.80), and oral (r = 0.61) and generic HRQoL (rho=-0.84). Self-efficacy and acceptance were also closely related to levels of depression (r/rho=-0.83 to -0.73) and generic HRQoL (r/rho = 0.74 to 0.75). These associations were stronger than those between pain severity and affective function/HRQoL and persisted after controlling for pain severity. CONCLUSIONS A substantial proportion of BMS patients evidence maladaptive beliefs about personal effectiveness in managing pain, which is closely related to affective disorders and impaired HRQoL. As such, treatment approaches targeting catastrophising, pain self-efficacy and acceptance may prove beneficial in improving mood and quality of life in BMS patients.
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Affiliation(s)
- Pavneet Chana
- Department of Oral Surgery, King's College London, Dental Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Jared G Smith
- Department of Oral Surgery, King's College London, Dental Hospital, King's College Hospital NHS Foundation Trust, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
| | - Aalia Karamat
- Community Oral Health Unit, Glasgow Dental School, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Anna Simpson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tara Renton
- Department of Oral Surgery, King's College London, Dental Hospital, King's College Hospital NHS Foundation Trust, London, UK
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Maathz P, Flink IK, Engman L, Ekdahl J. Psychological Inflexibility as a Predictor of Sexual Functioning Among Women with Vulvovaginal Pain: A Prospective Investigation. PAIN MEDICINE 2020; 21:3596-3602. [PMID: 32186737 PMCID: PMC7770233 DOI: 10.1093/pm/pnaa042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Persistent vulvovaginal pain affects many women and often has adverse effects on sexual functioning. Psychological inflexibility related to pain is associated with distress and functional disability across different types of chronic pain conditions, but little is known about the role of psychological inflexibility in vulvovaginal pain. The present study examines psychological inflexibility related to pain as a predictor of sexual functioning over time among women with vulvovaginal pain. Methods Questionnaires including measures of psychological inflexibility, pain severity, and sexual functioning were administered to female university students at two points in time. One hundred thirty women with vulvovaginal pain responded to the questionnaire at baseline and at follow-up after 10 months. A multiple regression model was used to explore psychological inflexibility and pain severity as predictors of sexual functioning at follow-up. Results Higher levels of psychological inflexibility and more severe pain at baseline were associated with poorer sexual functioning 10 months later. In analysis adjusting for baseline levels of sexual functioning, psychological inflexibility was the only significant predictor of sexual functioning at follow-up. Conclusions The findings provide preliminary evidence that psychological inflexibility is associated with sexual adjustment over time among women with vulvovaginal pain and point to the relevance of further examinations of the psychological inflexibility model in the context of vulvovaginal pain.
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Affiliation(s)
- Pernilla Maathz
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Ida K Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Linnea Engman
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
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Seangrung R, Ahuja M, Pasutharnchat K, Mahawan R. Factors influencing non-adherence to opioids in cancer patients: a mixed-methods cross-sectional study. F1000Res 2020; 9:1471. [PMID: 33815776 PMCID: PMC7984143 DOI: 10.12688/f1000research.27725.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 04/01/2024] Open
Abstract
Background: Strong opioids are mainly utilized to attenuate pain in cancer patients. Adherence to analgesic drugs significantly promotes adequate pain management and improves quality of life. We aimed to identify the factors influencing non-adherence to strong opioids in cancer patients. Methods: A descriptive, cross-sectional, two-phased, mixed methods design was conducted prospectively to evaluate a cohort of 101 cancer patients who are currently prescribed strong opioids from a pain clinic in Thailand between January and March 2018. Participants were asked to complete a questionnaire that included the following sections: general characteristics; the Medication Taking Behavior in Thai (MTB-Thai) for assessing adherence to medications; and factors influencing nonadherence, which were analyzed using multivariate logistic regression. In addition, face-to-face in depth interviews were conducted with patients showing non-adherence to strong opioids (MTB-Thai score ≤21) and analyzed using thematic content analysis. Results: Of 101 cancer pain patients that completed the questionnaire, 39.6% showed non-adherence to strong opioids. Illness understanding (P=0.047) and the use of more than three types of pain medication (P=0.032) were significant factors influencing non-adherence. Qualitative analysis indicated that fear of long-term outcomes, opioid side effects, ineffective pain control, attempts to make the regimen more acceptable, poor understanding, and non-acceptance of disease related to non-adherence. Conclusion: Non-adherence to opioids for cancer patients is a common problem. Awareness of patient factors, medication-related factors, and illness-related factors will provide the knowledge and adequate advice that may enhance adherence to medications.
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Affiliation(s)
- Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Mallika Ahuja
- Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, 30000, Thailand
| | - Koravee Pasutharnchat
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rungwipha Mahawan
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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Seangrung R, Ahuja M, Pasutharnchat K, Mahawan R. Factors influencing non-adherence to opioids in cancer patients: a mixed-methods cross-sectional study. F1000Res 2020; 9:1471. [PMID: 33815776 PMCID: PMC7984143 DOI: 10.12688/f1000research.27725.2] [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] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Strong opioids are mainly utilized to attenuate pain in cancer patients. Adherence to analgesic drugs significantly promotes adequate pain management and improves quality of life. We aimed to identify the factors influencing non-adherence to strong opioids in cancer patients. Methods: A descriptive, cross-sectional, two-phased, mixed methods design was conducted prospectively to evaluate a cohort of 101 cancer patients who are currently prescribed strong opioids from a pain clinic in Thailand between January and March 2018. Participants were asked to complete a questionnaire that included the following sections: general characteristics; the Medication Taking Behavior in Thai (MTB-Thai) for assessing adherence to medications; and factors influencing nonadherence, which were analyzed using multivariate logistic regression. In addition, face-to-face in depth interviews were conducted with patients showing non-adherence to strong opioids (MTB-Thai score ≤21) and analyzed using thematic content analysis. Results: Of 101 cancer pain patients that completed the questionnaire, 39.6% showed non-adherence to strong opioids. Illness understanding (P=0.047) and the use of more than three types of pain medication (P=0.032) were significant factors influencing non-adherence. Qualitative analysis indicated that fear of long-term outcomes, opioid side effects, ineffective pain control, attempts to make the regimen more acceptable, poor understanding, and non-acceptance of disease related to non-adherence. Conclusion: Non-adherence to opioids for cancer patients is a common problem. Awareness of patient factors, medication-related factors, and illness-related factors will provide the knowledge and adequate advice that may enhance adherence to medications.
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Affiliation(s)
- Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Mallika Ahuja
- Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, 30000, Thailand
| | - Koravee Pasutharnchat
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rungwipha Mahawan
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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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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Costa J, Marôco J, Pinto‐gouveia J, Ferreira N. Depression and physical disability in chronic pain: The mediation role of emotional intelligence and acceptance. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Joana Costa
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo‐Comportamental (CINEICC), Universidade de Coimbra, Coimbra, Portugal,
| | - João Marôco
- Unidade de Investigação em Psicologia e Saúde (UIPES), ISPA‐IU, Lisboa, Portugal,
| | - José Pinto‐gouveia
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo‐Comportamental (CINEICC), Universidade de Coimbra, Coimbra, Portugal,
| | - Nuno Ferreira
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland,
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Rabey M, Catley M, Vowles K, Appleton D, Bennett R, McAuley J. Development and preliminary validation of the Chronic Pain Acceptance Questionnaire for Clinicians. Scand J Pain 2020; 20:673-682. [PMID: 32701481 DOI: 10.1515/sjpain-2019-0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/20/2020] [Indexed: 11/15/2022]
Abstract
Background and Aims Higher chronic pain acceptance is associated with lower pain and disability. Clinician beliefs are associated with patients' beliefs. This study therefore aimed to develop the Chronic Pain Acceptance Questionnaire for Clinicians (CPAQ-C) to measure clinicians' beliefs regarding the importance of levels of acceptance in patients with chronic pain, and to examine the questionnaire's psychometric properties. Methods Phase one: the CPAQ-C was adapted from the Chronic Pain Acceptance Questionnaire. Data on 162 completed questionnaires were analysed using Rasch analysis. Phase Two: the cohort completed the Healthcare Providers Pain and Impairment Relationship Scale, and the association (Pearson's correlation co-efficient) between these questionnaires examined to assist CPAQ-C validation. Twenty-four participants completed the CPAQ-C one-week later. Test re-test reliability was examined using intraclass correlation co-efficient (2,1) and standard error of measurement. Phase Three: to examine responsiveness 17 clinicians attending a workshop on Acceptance and Commitment Therapy completed the CPAQ-C before and immediately after the workshop, and six-months later. The Skillings Mack test was used to determine whether CPAQ-C scores differed across different timepoints. Results Rasch analysis supported two subscales: activity engagement and pain willingness. Five poorly functioning items were excluded. There was good correlation between the CPAQ-C and Healthcare Providers Pain and Impairment Relationship Scale (-.54). The CPAQ-C demonstrated good reliability (ICC (2,1): .81; standard error of measurement: 4.76). There was significant improvement in CPAQ-C scores following the workshop (p=<.001). Conclusions The CPAQ-C appears a valid, reliable and responsive measure of clinicians' beliefs regarding the importance of levels of acceptance in patients with chronic pain. Implications Where the CPAQ-C reveals that clinicians have low perceived levels of importance regarding acceptance in patients with chronic pain those clinicians may benefit from specific education, however, this requires further examination.
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Affiliation(s)
- Martin Rabey
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,Thrive Physiotherapy, 66 Grande Rue, St. Martin, Guernsey, GY4 6LQ, British Isles
| | - Mark Catley
- Division of Health Sciences, University of South Australia, Adelaide, South Australia
| | - Kevin Vowles
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Richard Bennett
- School of Psychology, University of Birmingham, Birmingham, UK
| | - James McAuley
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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Villarreal YR, Stotts AL, Paniagua SM, Rosen K, Eckmann M, Suchting R, Potter JS. Mindfulness predicts current risk of opioid analgesic misuse in chronic low back pain patients receiving opioid therapy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Müller M, Bräscher AK. [Psychotherapy in the Context of Interdisciplinary Multimodal Pain Therapy: Update]. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:536-548. [PMID: 32916737 DOI: 10.1055/a-1022-3051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Interdisciplinary multimodal pain therapy (IMPT) is based on the biopsychosocial model of pain and describes an integrated treatment for patients with chronic pain. IMPT incorporates a close cooperation of different disciplines, including physicians, psychotherapists, physiotherapists, and others. IMPT mainly aims to restore and increase patients' physical, social and psychological functional capacity. The efficacy of IMPT has been evidenced by systematic reviews and meta-analyses. A number of studies further indicate IMPT's cost-efficiency. Psychotherapy is an essential component of IMPT. Its main goal within the framework of IMPT is to identify and modify dysfunctional patterns of pain coping, and to diagnose and potentially treat psychological comorbidities. Pain psychotherapy comprises mostly cognitive-behavioral interventions which address dysfunctional coping at the three levels of the pain experience (i.e., cognitive, emotional, and behavioral). Research into the efficacy of pain psychotherapy is rather sparse and studies have mostly focused on chronic back pain, yet existing results show promising evidence both for psychotherapy within IMPT and for psychotherapy as a monotherapy. This paper aims at providing an overview of (a) commonly employed cognitive-behavioral psychotherapeutic approaches and strategies in the treatment of chronic pain, and (b) the existing empirical evidence of pain psychotherapy both within the framework of IMPT and as a monotherapy. Future research should include a wider range of pain diagnoses and also investigate the potential benefit of individually-tailored treatments.
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The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review. J Clin Med 2020; 9:jcm9082486. [PMID: 32756298 PMCID: PMC7464293 DOI: 10.3390/jcm9082486] [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: 05/06/2020] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pain conditions are among the leading causes of global disability, impacting on global healthcare utilization (HCU). Health seeking behavior might be influenced by cognitive and emotional factors (CEF), which can be tackled by specific therapies. The purpose of this study was to systematically review the evidence concerning associations between CEF and HCU in people experiencing pain. Three databases were consulted: PubMed, Web of Science and EconLit. Risk of bias was assessed using the Downs and Black Checklist (modified). A total of 90 publications (total sample n = 59,719) was included after double-blind screening. In people experiencing pain, positive associations between general anxiety symptoms, depressive symptoms and catastrophizing and pain medication use were found. Additionally, there appears to be a relationship between general anxiety and depressive symptoms and opioid use. Symptom-related anxiety and psychological distress were found to be positively related with consulting behavior. Last, a positive association between use of complementary and alternative medicine and level of perceived symptom control was confirmed in people with pain. For other relationships no evidence or inconsistent findings were found, or they were insufficiently studied to draw firm conclusions, indicating that more research on this topic is needed.
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Esteve R, López-Martínez AE, Ruíz-Párraga GT, Serrano-Ibáñez ER, Ramírez-Maestre C. Pain Acceptance and Pain-Related Disability Predict Healthcare Utilization and Medication Intake in Patients with Non-Specific Chronic Spinal Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155556. [PMID: 32752085 PMCID: PMC7432233 DOI: 10.3390/ijerph17155556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023]
Abstract
Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months’ duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability—understood as giving up normal activities—can lead to reductions in healthcare utilization and medication intake.
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Affiliation(s)
- Rosa Esteve
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Alicia Eva López-Martínez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Gema Teresa Ruíz-Párraga
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Elena Rocío Serrano-Ibáñez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Facultad de Ciencias de la Salud, Área de Psicología, Universidad Isabel I, 09003 Burgos, Spain
| | - Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Correspondence: ; Tel.: +34-952-132-389
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Vasigh A, Tarjoman A, Borji M. Relationship Between Spiritual Health and Pain Self-Efficacy in patients with Chronic Pain: A Cross-Sectional Study in West of Iran. JOURNAL OF RELIGION AND HEALTH 2020; 59:1115-1125. [PMID: 31087227 DOI: 10.1007/s10943-019-00833-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In recent years, the prevalence of chronic diseases has had a growing trend, which has resulted in many health problems. Level of belief in God is effective on people's attitudes to life concepts, social deviations and psychological disorders, and improves them. Therefore, the present research was conducted with the aim of determining the relationship between spiritual health (SH) and pain self-efficacy (PSE) in Ilam City in 2018. This study was a descriptive cross-sectional study in the group of patients with chronic pain (CP). In this study, the study population was patients with CP in Ilam City and the study sample was 150 patients with CP referring to public and private health centers in Ilam, which had all the criteria for participation in the study. The findings showed mean (SD) of the total score of SH variables was 65.16 (9.88), and PSE was 34.48 (4.08). According to Pearson statistical analysis, there is a significant relationship between SH and PSE (r = 0.442, P = 0.000). Also, the standard beta and non-standard beta coefficients for SH variables in PSE show that the non-standard beta coefficient in SH is equal to 0.183. The results of this study showed that SH is a predictor of pain acceptance, so that patients who were more religious were more likely to tolerate CP. For this reason, it is suggested that religious interventions be performed to reduce pain in patients with CP, in order to provide the necessary context for pain reduction in this group of patients.
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Affiliation(s)
- Aminollah Vasigh
- Department of Anesthesiology, Medicine Faculty, Ilam University of Medical Science, Ilam, Islamic Republic of Iran
| | - Asma Tarjoman
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran.
| | - Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Islamic Republic of Iran
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Pinel L, Perez-Nieto MA, Redondo M, Rodríguez-Rodríguez L, León L. Anxiety, Reinforcement Sensitivity and Social Context in Accepting the Experience of Pain Among Rheumatoid Arthritis Patients. Front Psychiatry 2020; 11:554990. [PMID: 33324249 PMCID: PMC7723888 DOI: 10.3389/fpsyt.2020.554990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Acceptance has become one of the most widely studied processes regarding chronic pain because of its ability to influence participants' adaptation and coping responses. Leading researchers have found relationships between variables such as anxiety, reinforcement sensitivity, and the responses of the participants' environment to their behavior and acceptance. In contrast, few studies have been found that investigate the variables that predict the acceptance of pain. This study has set out to explore the relationships between pain-related anxiety, sensitivity to contingencies, and the punishment responses of significant people toward pain behaviors regarding pain acceptance. Methods: With a view to fulfilling this purpose, a cohort of 62 participants with rheumatoid arthritis was chosen, and the subjects were assessed through the following self-report measures: Chronic Pain Acceptance Questionnaire, CPAQ; Pain Anxiety Symptoms Scale, PASS-20; The Sensitivity to Punishment and Sensitivity to Reward Questionnaire, SPSRQ, and The West Haven-Yale Multidimensional Pain Inventory, WHYMPI. The study's initial objectives were achieved by means of a stepwise multiple linear regression analysis. Results: The linear regression analyses revealed a negative and significant correlation between anxiety, reinforcement sensitivity, and the significant persons' responses to pain behaviors and pain acceptance. Conclusion: The results suggest that the identification of these variables might be important for addressing these participants' pain. Finally, the discussion focuses on our findings' implications as regards their use in clinical practice.
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Affiliation(s)
- Luis Pinel
- Faculty of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Marta Redondo
- Faculty of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Leticia León
- Faculty of Education and Health, Camilo José Cela University, Madrid, Spain
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Trompetter HR, Johnston DW, Johnston M, Vollenbroek-Hutten MM, Schreurs KMG. Are Processes in Acceptance & Commitment Therapy (ACT) Related to Chronic Pain Outcomes Within Individuals Over Time? An Exploratory Study Using n-of-1 Designs. J Pers Oriented Res 2019; 5:123-136. [PMID: 33569147 PMCID: PMC7842648 DOI: 10.17505/jpor.2019.11] [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] [Indexed: 11/06/2022] Open
Abstract
Introduction Acceptance & Commitment Therapy (ACT) explicitly postulates experiential avoidance (EA) and values-based living (VBL) as essential treatment processes. As outcomes from between-subject studies cannot readily be generalized to within-subject processes in individuals, we explored the unfolding of, and relationship between, EA and VBL and levels of pain interference in daily life and emotional well-being within individuals experiencing chronic pain. Methods Using n-of-1 designs, three participants following a multidisciplinary treatment program filled out a 12-item daily questionnaire (87-110 days). After multiple imputation of missing data, McKnight Time-series analysis procedures were performed for each participant separately. The interrelationships of EA, VBL and pain intensity, and the relationship of EA and VBL beyond pain intensity with both chronic pain outcomes were assessed both concurrently (same day) and prospectively (consecutive days). Results Both EA and VBL were associated with at least one of five outcome variables (four domains of pain interference and emotional well-being) beyond pain intensity in two participants, but not in the third participant. These associations primarily existed for concurrent, but not consecutive, days. In contrast to VBL, EA was not associated with emotional well-being for any of the three participants. Conclusions Although the finding that ACT-processes were associated with pain outcomes on concurrent days is consistent with ACT theory, the absence of such associations on consecutive days means that alternative explanations cannot be rule out. One possibility is that pain interference fluctuates within days at a higher variability rate than was currently assessed. Future research should consider using a higher measurement frequency to be able to grasp time-lagged effects.
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Affiliation(s)
- Hester R Trompetter
- Department of Psychology, Health and Technology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands.,Roessingh Research and Development, Telemedicine group, Postbox 310, 7500 AH, Enschede, The Netherlands
| | - Derek W Johnston
- School of Psychology, College of Life Sciences and Medicine, William Guild Building, University of Aberdeen, Aberdeen AB24 3FX, Scotland
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, College of Life Sciences and Medicine, Health Sciences Building, Aberdeen AB25 2ZD, Scotland
| | - Miriam M Vollenbroek-Hutten
- Roessingh Research and Development, Telemedicine group, Postbox 310, 7500 AH, Enschede, The Netherlands.,Faculty of Engineering, Mathematics and Computer Sience, Telemedicine group, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands
| | - Karlein M G Schreurs
- Roessingh Research and Development, Telemedicine group, Postbox 310, 7500 AH, Enschede, The Netherlands
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Trompetter HR, Mols F, Westerhof GJ. Beyond Adaptive Mental Functioning With Pain as the Absence of Psychopathology: Prevalence and Correlates of Flourishing in Two Chronic Pain Samples. Front Psychol 2019; 10:2443. [PMID: 31749743 PMCID: PMC6848389 DOI: 10.3389/fpsyg.2019.02443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/15/2019] [Indexed: 11/25/2022] Open
Abstract
Chronic pain outcomes are traditionally defined in terms of disability and illness. A definition of adaptive functioning in the context of chronic pain beyond the mere absence of negative outcomes, is the ability to flourish (i.e., experience emotional, psychological and social well-being; Keyes, 2002). We explored in two chronic pain samples the prevalence and sociodemographic, physical and psychological correlates of flourishing, and complemented this exploration with a similar examination of (being at risk for) psychopathology to help contextualize findings. Sample 1 (n = 1498) was a nationally representative sample. Subgroups included people with regular joint pain (1), regular joint pain and rheumatoid arthritis (2) and without chronic pain (3). Using chi-square tests we calculated the prevalence of both mental health outcomes and examined if people with or without chronic pain were more/less likely to flourish/at risk for psychopathology. Sample 2 (n = 238) concerned baseline data of a Randomized Controlled Trial on the effectiveness of Acceptance and Commitment Therapy for chronic pain (Trompetter et al., 2015b). We performed logistic regression analysis to identify flourishers/those at risk for depression. The Mental Health Continuum-Short Form was used to measure flourishing. The prevalence of flourishing was 34% (recurrent joint pain) and 38% (recurrent joint pain and arthritis) in sample 1, and 23% in sample 2. Compared to those without chronic pain, people with chronic pain were as likely to flourish, but more likely to be at risk for psychopathology. In sample 2, both flourishing and being at risk for depression were related foremost to psychological correlates. While engaged living was the most important correlate of flourishing, pain catastrophizing and psychological inflexibility were most important correlates of being at risk for depression. In conclusion, people with chronic pain are able to flourish. Findings suggest that positive and negative chronic pain outcomes function on two different continua, with potentially unique protective and risk factors. The Psychological Flexibility model provides pathways to explain both poor and optimal functioning in the presence of chronic pain. A better understanding of people with chronic pain who are able to flourish can be a fruitful endeavor to improve chronic pain models and interventions.
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Affiliation(s)
- Hester R. Trompetter
- CoRPS – Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Floortje Mols
- CoRPS – Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Gerben J. Westerhof
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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The Impact of Perceived Injustice on Pain-related Outcomes: A Combined Model Examining the Mediating Roles of Pain Acceptance and Anger in a Chronic Pain Sample. Clin J Pain 2019; 34:739-747. [PMID: 29485535 DOI: 10.1097/ajp.0000000000000602] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Perceived injustice (PI) has been identified as an important risk factor for pain-related outcomes. To date, research has shown that pain acceptance and anger are mediators of the association between PI and pain-related outcomes. However, a combined conceptual model that addresses the interrelationships between these variables is currently lacking. Therefore, the current study aimed to examine the potential mediating roles of pain acceptance and anger on the association between PI and adverse pain-related outcomes (physical function, pain intensity, opioid use status). MATERIALS AND METHOD This cross-sectional study used a sample of 354 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of PI, pain acceptance, anger, physical function, pain intensity, and opioid use status. Mediation analyses were used to examine the impact of pain acceptance and anger on the association between PI and pain-related outcomes. RESULTS Examination of the specific indirect effects revealed that pain acceptance fully mediated the relationship between PI and physical function, as well as the relationship between PI and opioid use status. Pain acceptance emerged as a partial mediator of the relationship between PI and pain intensity. DISCUSSION This is the first study to provide a combined conceptual model investigating the mediating roles of pain acceptance and anger on the relationship between PI and pain outcomes. On the basis of our findings, low levels of pain acceptance associated with PI may help explain the association between PI and adverse pain outcomes. Clinical and theoretical implications are discussed.
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Ravn SL, Vang ML, Vaegter HB, Andersen TE. Pain-Related Acceptance as a Mediator in the Fear Avoidance Model of Chronic Pain: A Preliminary Study. PAIN MEDICINE 2019; 19:1764-1771. [PMID: 29036699 DOI: 10.1093/pm/pnx223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective The fear avoidance model has served as a popular, heuristic model in explaining the transition from acute to chronic pain. In addition, the significance of pain-related acceptance in chronic pain development and adjustment is underlined in a vast number of empirical studies. The objective of the current preliminary study was to investigate pain-related acceptance as a mediator within the key cognitive relationships proposed by the fear avoidance model of chronic pain. Materials and Methods. In a cross-sectional design, bodily pain, pain catastrophizing, fear avoidance beliefs, and pain-related acceptance were assessed by questionnaires in 125 chronic pain patients in a Danish multidisciplinary pain center. Mediation analyses were performed to test the effect of pain-related acceptance on bodily pain, pain catastrophizing, and fear avoidance beliefs. Results Medium-sized correlations were found between all outcomes. Mediation analyses revealed that pain-related acceptance was a significant mediator between 1) bodily pain and pain catastrophizing and 2) pain catastrophizing and fear avoidance beliefs after controlling for bodily pain. Furthermore, pain-related acceptance accounted for a large proportion in both associations (82.2% and 56.1%). Conclusions The results suggest that pain-related acceptance is a prominent psychological mechanism within the key cognitive associations of the fear avoidance model, which predicts a certain path of cognitive, emotional, and behavioral factors in the development and maintenance of chronic pain. This proposes pain-related acceptance to be an important mechanism that possibly counteracts the negative reactions of pain catastrophizing and fear avoidance beliefs. These findings should be investigated further and could potentially be an important place to intervene clinically in order to counteract the development and/or maintenance of chronic pain.
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Affiliation(s)
- Sophie Lykkegaard Ravn
- Departments of Psychology.,The Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | | | - Henrik Bjarke Vaegter
- Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Anesthesiology and Intensive Care Medicine, Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark
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Kanzler KE, Pugh JA, McGeary DD, Hale WJ, Mathias CW, Kilpela LS, Karns-Wright TE, Robinson PJ, Dixon SA, Bryan CJ, Moring JC, McCracken LM. Mitigating the Effect of Pain Severity on Activity and Disability in Patients with Chronic Pain: The Crucial Context of Acceptance. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1509-1518. [PMID: 30590737 PMCID: PMC6686120 DOI: 10.1093/pm/pny197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effect of pain severity on activity levels and physical disability in the context of high pain acceptance. We hypothesized that pain acceptance moderates the effect of pain severity on general activity and physical disability, such that at higher levels of acceptance, the deleterious effect of pain is mitigated. METHODS Two hundred seven patients with chronic pain were recruited from three clinics in a large southwestern military treatment facility. Participants completed an anonymous self-report battery of standardized measures, including the Chronic Pain Acceptance Questionnaire, modified Oswestry Disability Index, and Pain Severity and General Activity subscales of the West Haven-Yale Multidimensional Pain Inventory. RESULTS Chronic pain acceptance was found to significantly moderate relations between pain severity and general activity (b = 0.0061, t(198) = 2.75, P = 0.007, 95% confidence interval [CI] = 0.002 to 0.011) and pain severity and disability (b = 0.036, t(193) = -2.564, P = 0.011, 95% CI = -0.063 to -0.008). In the context of higher acceptance, the negative effect of pain on activity and disability appeared reduced. Conversely, in the context of low acceptance, the effect of pain on disability appeared accentuated at all levels of pain severity. CONCLUSIONS Higher acceptance mitigated both activity level and disability in a military-affiliated clinical sample of patients with chronic pain. Results further establish the role of acceptance in relation to functioning in a unique sample of people with chronic pain. These findings have implications for understanding and enhancing functioning in chronic pain populations.
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Affiliation(s)
- Kathryn E Kanzler
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Jacqueline A Pugh
- South Texas Veterans Health Care System
- Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Donald D McGeary
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Charles W Mathias
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Lisa S Kilpela
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Tara E Karns-Wright
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | | | - Sara A Dixon
- 81 DS/SGD Orofacial Pain, Keesler Air Force Base
| | - Craig J Bryan
- National Center for Veterans Studies and Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | | | - Lance M McCracken
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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The Impact of a Group-Based Multidisciplinary Rehabilitation Program on the Quality of Life in Patients With Fibromyalgia. ACTA ACUST UNITED AC 2019; 26:313-319. [DOI: 10.1097/rhu.0000000000001120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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