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Buhrman M, Hällström H, Fridén A, Kettis Moden E, Grahn G, Carlfjord M, Hjo C, Gasslander N, Bohm-Starke N, McCracken LM. Guided internet-based acceptance and commitment therapy for provoked vestibulodynia: A randomized controlled trial. Eur J Pain 2024; 28:1185-1201. [PMID: 38429870 DOI: 10.1002/ejp.2253] [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: 07/18/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Provoked vestibulodynia (PVD) causes suffering in many women's lives due to its impact on relationships, sexual functioning and functioning in other key domains. OBJECTIVE Here, we report a randomized controlled trial conducted to examine whether Acceptance and Commitment Therapy (ACT) with a focus on values-based exposure, delivered online, benefits women with PVD. METHODS Participants (n = 88) were randomized to either guided online ACT for 10 weeks or a wait-list control group. Outcomes were assessed at baseline, post treatment and 1 year later. Analyses were based on intention to treat using linear mixed models. RESULTS There were significant group differences on the primary outcomes, Female Sexual Index and Female Sexual Distress Scale, in favour of online ACT with moderate effect sizes. Differences were also found on several secondary outcomes and therapeutic process measures, all in favour of ACT. No differences were found at post-treatment for depression or anxiety. At the 1-year follow-up, results were maintained and a difference between baseline and follow-up was also found for depression. CONCLUSION/SIGNIFICANCE In summary, a relatively brief, guided, online version of ACT appears to produce benefits for women with PVD and related impacts on daily functioning. 50% to 60% of the women who participated in the treatment reliably improved in sexual functioning and distress.
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Affiliation(s)
- Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Hanna Hällström
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Annika Fridén
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Emma Kettis Moden
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gunnar Grahn
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Maja Carlfjord
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Camille Hjo
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nils Gasslander
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nina Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institute, Solna, Sweden
- Danderyd Hospital, Stockholm, Sweden
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
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You DS, Chong JL, Mackey SC, Poupore-King H. Utilizing a learning health system to capture real-world patient data: Application of the reliable change index to evaluate and improve the outcome of a pain rehabilitation program. Pain Pract 2024; 24:856-865. [PMID: 38465804 DOI: 10.1111/papr.13364] [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] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND OBJECTIVES The learning healthcare system (LHS) has been developed to integrate patients' clinical data into clinical decisions and improve treatment outcomes. Having little guidance on this integration process, we aim to explain (a) an applicable analytic tool for clinicians to evaluate the clinical outcomes at a group and an individual level and (b) our quality improvement (QI) project, analyzing the outcomes of a new outpatient pain rehabilitation program ("Back-in-Action": BIA) and applying the analysis results to modify our clinical practice. METHODS Through our LHS (CHOIR; https://choir.stanford.edu), we administered the Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ), and Patient-Reported Outcomes Measures (PROMIS)® before and after BIA. After searching for appropriate analytic tools, we decided to use the Reliable Change Index (RCI) to determine if an observed change in the direction of better (improvement) or worse (deterioration) would be beyond or within the measurement error (no change). RESULTS Our RCI calculations revealed that at least a 9-point decrease in the PCS scores and 10-point increase in the CPAQ scores would indicate reliable improvement. RCIs for the PROMIS measures ranged from 5 to 8 T-score points (i.e., 0.5-0.8 SD). When evaluating change scores of the PCS, CPAQ, and PROMIS measures, we found that 94% of patients showed improvement in at least one domain after BIA and 6% showed no reliable improvement. CONCLUSIONS Our QI project revealed RCI as a useful tool to evaluate treatment outcomes at a group and an individual level, and RCI could be incorporated into the LHS to generate a progress report automatically for clinicians. We further explained how clinicians could use RCI results to modify a clinical practice, to improve the outcomes of a pain program, and to develop individualized care plans. Lastly, we suggested future research areas to improve the LHS application in pain practice.
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Affiliation(s)
- Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jeanette L Chong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Heather Poupore-King
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Sturgeon JA, Zubieta C, Kaplan CM, Pierce J, Arewasikporn A, Slepian PM, Hassett AL, Trost Z. Broadening the Scope of Resilience in Chronic Pain: Methods, Social Context, and Development. Curr Rheumatol Rep 2024; 26:112-123. [PMID: 38270842 DOI: 10.1007/s11926-024-01133-0] [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] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW A wellspring of new research has offered varying models of resilience in chronic pain populations; however, resilience is a multifaceted and occasionally nebulous construct. The current review explores definitional and methodological issues in existing observational and clinical studies and offers new directions for future studies of pain resilience. RECENT FINDINGS Definitions of pain resilience have historically relied heavily upon self-report and from relatively narrow scientific domains (e.g., positive psychology) and in narrow demographic groups (i.e., Caucasian, affluent, or highly educated adults). Meta-analytic and systematic reviews have noted moderate overall quality of resilience-focused assessment and treatment in chronic pain, which may be attributable to these narrow definitions. Integration of research from affiliated fields (developmental models, neuroimaging, research on historically underrepresented groups, trauma psychology) has the potential to enrich current models of pain resilience and ultimately improve the empirical and clinical utility of resilience models in chronic pain.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Caroline Zubieta
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chelsea M Kaplan
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Pierce
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anne Arewasikporn
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - P Maxwell Slepian
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, CA, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zina Trost
- Department of Psychology, Texas A&M University, College Station, TX, USA
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Vowles KE, Kruger ES, Bailey RW, Ashworth J, Hickman J, Sowden G, McCracken LM. The Pain Anxiety Symptom Scale: Initial Development and Evaluation of 4 and 8 Item Short Forms. THE JOURNAL OF PAIN 2024; 25:176-186. [PMID: 37574179 DOI: 10.1016/j.jpain.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/30/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
Elevated levels of anxiety in relation to chronic pain have been consistently associated with greater distress and disability. Thus, accurate measurement of pain-related anxiety is an important requirement in modern pain services. The Pain Anxiety Symptom Scale (PASS) was introduced over 30 years ago, with a shortened 20-item version introduced 10 years later. Both versions of the PASS were derived using Principal Components Analysis, an established method of measure development with roots in classical test theory. Item Response Theory (IRT) is a complementary approach to measure development that can reduce the number of items needed and maximize item utility with minimal loss of statistical and clinical information. The present study used IRT to shorten the 20-item PASS (PASS-20) in a large sample of people with chronic pain (N = 2,669). Two shortened versions were evaluated, 1 composed of the single best-performing item from each of its 4 subscales (PASS-4) and the other with the 2 best-performing items from each subscale (PASS-8). Several supplementary analyses were performed, including comparative item convergence evaluations based on sample characteristics (ie, female or male sex; clinical or online sample), factor invariance testing, and criterion validity evaluation of the 4, 8, and 20-item versions of the PASS in hierarchical regression models predicting pain-related distress and interference. Overall, both shortened PASS versions performed adequately across these supplemental tests, although the PASS-4 had more consistent item convergence between samples, stronger evidence for factor invariance, and accounted for 83% of the variance accounted for by the PASS-20% and 92% of the variance accounted for by the PASS-8 in criterion variables. Consequently, the PASS-4 is recommended for use in situations where a briefer evaluation of pain-related anxiety is appropriate. PERSPECTIVE: The Pain Anxiety Symptom Scale (PASS) is an established measure of pain-related fear. This study derived 4 and 8-item versions of the PASS using IRT. Both versions showed strong psychometric properties, stability of factor structure, and relation to important aspects of pain-related functioning.
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Affiliation(s)
- Kevin E Vowles
- School of Psychology, Queen's University Belfast and Belfast Centre for Pain Rehabilitation, Belfast City Hospital, National Health Service (NHS), Belfast, Northern Ireland, UK
| | - Eric S Kruger
- Division of Physical Therapy, University of New Mexico, Albuquerque, New Mexico
| | - Robert W Bailey
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
| | - Julie Ashworth
- Midlands Partnership NHS Foundation Trust, Staffordshire, UK; School of Medicine, Keele University, Keele, UK
| | - Jayne Hickman
- UK Pain Service, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Gail Sowden
- School of Medicine, Keele University, Keele, UK; Connect Health, Newcastle upon Tyne, UK
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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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Hollyfield S, Travers W, Sondh SK, Wilczek A, Jacobs C, McCracken LM, Scott W. An Observational Study of Outcomes Associated With Virtual Pain Management Programs Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic. Clin J Pain 2023; 39:524-536. [PMID: 37449794 PMCID: PMC10498868 DOI: 10.1097/ajp.0000000000001144] [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: 02/16/2023] [Revised: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE In response to COVID-19, virtual, group-based interdisciplinary pain management programs (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low-intensity and pre-neuromodulation PMPs based on acceptance and commitment therapy as part of routine care during the pandemic. METHODS Depending on patients' needs, participants completed a virtual high-intensity or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 to 2019 for in-person residential ( n= 561), outpatient ( n =123), and pre-neuromodulation ( n =207) PMPs were also examined to provide a historical benchmark of performance. RESULTS The virtual high-intensity PMP ( n =294) showed significant improvements in all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP ( n =129). No statistically significant improvements were observed for the virtual low-intensity PMP ( n =90). The improvements associated with prepandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic. DISCUSSION These data provide preliminary support for the potential benefits of high, but not low, intensity virtual acceptance and commitment therapy-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.
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Affiliation(s)
| | - Warren Travers
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | | | - Angelika Wilczek
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | - Clair Jacobs
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | | | - Whitney Scott
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
- King’s College London, Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
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7
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Hale W, Vacek S, Crabtree M, Grelle K, Bryan CJ, McGeary DD, Kanzler KE. The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:993-1000. [PMID: 37027224 PMCID: PMC10391590 DOI: 10.1093/pm/pnad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE The purpose of this study was (1) to examine the degree to which perceived burdensomeness mediates the relationship between pain severity and suicidal cognitions and (2) to determine whether this mediated relationship was moderated by pain acceptance. We predicted that high levels of pain acceptance would buffer relationships on both paths of the indirect effect. METHODS Two-hundred seven patients with chronic pain completed an anonymous self-report battery of measures, including the Chronic Pain Acceptance Questionnaire, the Interpersonal Needs Questionnaire, the Suicidal Cognitions Scale, and the pain severity subscale of the West Haven-Yale Multidimensional Pain Inventory. Conditional process models were examined with Mplus. RESULTS Chronic pain acceptance significantly moderated both paths of the mediation model. Results from the conditional indirect effect model indicated that the indirect effect was significant for those with low (b = 2.50, P = .004) and medium (b = 0.99, P = .01) but not high (b = 0.08, P = .68) levels of pain acceptance and became progressively stronger as pain acceptance scores decreased. The nonlinear indirect effect became nonsignificant at acceptance scores 0.38 standard deviation above the mean-a clinically attainable treatment target. CONCLUSIONS Higher acceptance mitigated the relationship between pain severity and perceived burdensomeness and the relationship between perceived burdensomeness and suicidal cognitions in this clinical sample of patients experiencing chronic pain. Findings indicate that any improvement in pain acceptance can be beneficial, and they provide clinicians with a clinical cut-point that might indicate lower vs higher suicide risk.
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Affiliation(s)
- Willie Hale
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Sarah Vacek
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Meghan Crabtree
- Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Ft. Collins, CO, United States
| | - Kaitlin Grelle
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, OH, United States
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Kathryn E Kanzler
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houtson, TX, United States
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Franken K, Schuffelen P, ten Klooster P, van Doesum K, Westerhof G, Bohlmeijer E. Introduction of the generic sense of ability to adapt scale and validation in a sample of outpatient adults with mental health problems. Front Psychol 2023; 14:985408. [PMID: 37063565 PMCID: PMC10090661 DOI: 10.3389/fpsyg.2023.985408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/02/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionThe ability to adapt is a core aspect of daily human life. Recent models and theories emphasize its essential role for health and well-being. It concerns the perceived ability to readjust and actively deal with the psychosocial consequences of challenging events. While many questionnaires measure competences related to adaptability to specific conditions, a scale that measures a generic sense of the ability to adapt is lacking. The aim of the present study is to introduce the Generic Sense of Ability to Adapt Scale (GSAAS) and to examine its psychometric properties.MethodsThe article describes two sub-studies. In the first study the items of the GSAAS were generated and field-tested in a cross-sectional non-clinical sample using item analysis, exploratory factor analysis and Rasch analysis.ResultsThis resulted in a 10-item questionnaire measuring a single dimension with good reliability (Cronbach’s α = 0.87). In the second study the 10-item scale was validated using a cross-sectional sample of 496 outpatient adults with mental health problems. Confirmatory factor analysis confirmed the unidimensional structure of the GSAAS and the absence of measurement variance across gender, age and education. Reliability was high (α = 0.89) and moderate to strong correlations between the GSAAS and concurrent validation measures confirmed its convergent validity. Regarding incremental validity, the GSAAS accounted for 7.4% additional explained variance in symptomatic distress above and beyond sense of coherence.DiscussionIn conclusion, the GSAAS appears to be a reliable and valid instrument to assess people’s generic sense of the ability to adapt. It is a practical and quick tool that can be used to measure a vital aspect of health in research and clinical treatment settings.
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Affiliation(s)
- Katinka Franken
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- GGNet Centre of Mental Health, Apeldoorn, Netherlands
- *Correspondence: Katinka Franken,
| | - Pauline Schuffelen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Mindfit, Deventer, Netherlands
| | - Peter ten Klooster
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | | | - Gerben Westerhof
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- GGNet Centre of Mental Health, Apeldoorn, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
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Buskbjerg C, O'Toole MS, Zachariae R, Jensen AB, Frederiksen Y, Johansen C, von Heymann A, Speckens A, Johannsen M. Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark. BMJ Open 2023; 13:e066505. [PMID: 36948567 PMCID: PMC10040060 DOI: 10.1136/bmjopen-2022-066505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION One in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design. METHODS AND ANALYSIS The study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18-75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive-behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance. ETHICS AND DISSEMINATION Ethical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05444101).
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Affiliation(s)
- Cecilie Buskbjerg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Yoon Frederiksen
- Deparment of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- The Sexology Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maja Johannsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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10
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Reilly ED, Kathawalla UK, Robins HE, Heapy AA, Hogan TP, Waring ME, Quigley KS, Drebing CE, Bickmore T, Volonte M, Kelly MM. An Online Acceptance and Mindfulness Intervention for Chronic Pain in Veterans: Development and Protocol for a Pilot Feasibility Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e45887. [PMID: 36881446 PMCID: PMC10031449 DOI: 10.2196/45887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning. OBJECTIVE The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20). METHODS This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system. RESULTS This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023. CONCLUSIONS The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning. TRIAL REGISTRATION ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45887.
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Affiliation(s)
- Erin D Reilly
- Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, Bedford, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ummul-Kiram Kathawalla
- Wheelock College of Education & Human Development, Boston University, Boston, MA, United States
| | | | - Alicia A Heapy
- Pain Research, Informatics, Multi-morbidities, and Education Center, Veterans Affairs Connecticut Healthcare System, Department of Veterans Affairs, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Karen S Quigley
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Charles E Drebing
- Cheyenne Veterans Affairs Medical Center, Department of Veterans Affairs, Cheyenne, WY, United States
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Matias Volonte
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Megan M Kelly
- Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, Bedford, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
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11
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Hansen KE, Brandsborg B, Kesmodel US, Forman A, Kold M, Pristed R, Donchulyesko O, Hartwell D, Vase L. Psychological interventions improve quality of life despite persistent pain in endometriosis: results of a 3-armed randomized controlled trial. Qual Life Res 2023; 32:1727-1744. [PMID: 36797461 PMCID: PMC10172241 DOI: 10.1007/s11136-023-03346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Despite standard medical treatment endometriosis is often associated with disabling pain and poor quality of life (QoL). Studies indicate that psychological interventions (PIs) may improve pain and QoL, yet studies on the effects of PIs for women with endometriosis are sparse and limited by low-quality study designs. Therefore, this study aimed, in a rigorous three-armed design, to evaluate the effect of PIs on chronic pelvic pain (CPP) and QoL in women with endometriosis. METHODS This three-armed parallel, multi-center randomized controlled trial included fifty-eight endometriosis patients reporting severe CPP [≥ 5 for pain intensity measured on a 0-10-point numeric rating scale (NRS)]. Patients were randomly assigned to (1) Specific mindfulness- and acceptance-based psychological intervention (MY-ENDO), (2) Carefully matched non-specific psychological intervention (Non-specific), or (3) A wait-list control group (WL). The primary outcome was pelvic pain intensity/unpleasantness measured on NRS. Secondary outcomes included endometriosis-related quality of life, workability, pain acceptance, and endometriosis-related symptoms. Differences in outcomes between groups at post-treatment follow-up were analyzed using mixed linear models. Analyses were performed on an intention-to-treat basis. RESULTS Compared to WL, psychological intervention (MY-ENDO + Non-specific) did not significantly reduce pain. However, psychological intervention did significantly improve the QoL-subscales 'control and powerlessness', 'emotional well-being', and 'social support' as well as the endometriosis-related symptoms 'dyschezia' and 'constipation'. MY-ENDO was not superior to Non-specific. CONCLUSIONS Women with endometriosis may have significant and large effects of psychological intervention on QoL despite an ongoing experience of severe CPP. TRIAL REGISTRATION 12 April 2016, clinicaltrials.gov (NCT02761382), retrospectively registered.
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Affiliation(s)
- K E Hansen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark. .,Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, 8000, Aarhus, Denmark.
| | - B Brandsborg
- Department of Clinical Medicine, Aarhus University, 8210, Aarhus, Denmark
| | - U S Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | - A Forman
- Department of Clinical Medicine, Aarhus University, 8210, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8210, Aarhus, Denmark
| | - M Kold
- Department of Communication and Psychology, The Faculty of Social Sciences and Humanities (SSH), Aalborg University, 9000, Aalborg, Denmark
| | - R Pristed
- Department of Psychological Health, Agder University, Agder, Norway
| | - O Donchulyesko
- Department of Obstetrics and Gynaecology, North Denmark Regional Hospital, Hjørring, Denmark
| | - D Hartwell
- Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, 8000, Aarhus, Denmark
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12
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Malpus Z, Nazar Z, Smith C, Armitage L. Compassion focused therapy for pain management: '3 systems approach' to understanding why striving and self-criticism are key psychological barriers to regulating activity and improving self-care for people living with persistent pain. Br J Pain 2023; 17:87-102. [PMID: 36815069 PMCID: PMC9940251 DOI: 10.1177/20494637221133630] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background This paper describes the development of an eight-week Compassion Focused Therapy for Pain Management (CFT-PM) group. This group was specifically designed for 'strivers' a sub-group of people with persistent pain who tend to engage in over-activity and resist making reasonable adjustments to their activity levels to accommodate their persistent pain. 'Strivers' tend to cope by ignoring their pain and pushing on through, in the shorter term leading to 'boom and bust' activity-related exacerbations of their pain. They also risk the development of additional persistent fatigue and burnout in the longer term. Method 117 people completed the CFT-PM group; The group was delivered in person (n = 84) but in online format from July 2020 (n = 33). 162 people started the CFT-PM group but 45 dropped-out (27.43%). Results There was a significant effect for time across all measures: significant improvement was found for depression, self-compassion, pain-related disability, pain-related anxiety and pain self-efficacy. Pain numeric rating scores were approaching significance. There was a significant main effect of diagnosis; post-hoc t-test analysis found significant improvement for all diagnoses on all measures with the exception of spinal. There was also a significant interaction between time and format: post-hoc t-test analysis found greater improvement for virtual format on self-compassion and pain-related anxiety. Discussion Findings suggests that CFT-PM may be a clinically effective group intervention with virtual format showing superior improvement. This approach might be less suitable for certain diagnoses; the spinal group may benefit more from traditional CBT-based PMPs. Limitations include the lack of random selection or allocation to treatment group. Future studies should adopt an experimental design to be able to draw firm conclusions regarding causation and efficacy. Despite these limitations, present findings suggest that CFT-PM may be an effective group intervention worthy of further investigation and clinical application.
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Affiliation(s)
- Zoey Malpus
- Manchester NHS Pain Service, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zaynab Nazar
- Trainee Health Psychologist, Manchester Metropolitan University, Manchester, UK
| | | | - Lesley Armitage
- Medical Psychology Service, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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13
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Garland EL, Roberts RL, Hanley AW, Zeidan F, Keefe FJ. The Mindful Reappraisal of Pain Scale (MRPS): Validation of a New Measure of Psychological Mechanisms of Mindfulness-Based Analgesia. Mindfulness (N Y) 2023; 14:192-204. [PMID: 37901118 PMCID: PMC10611443 DOI: 10.1007/s12671-022-02034-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
Objectives Mindfulness is theorized to decrease the affective amplification of chronic pain by facilitating a shift from emotionally-laden, catastrophic pain appraisals of nociceptive input to reappraising chronic pain as an innocuous sensory signal that does not signify harm. Understanding of these hypothetical psychological mechanisms of mindfulness-based analgesia has been limited by a lack of direct measures. We conducted a series of psychometric and experimental studies to develop and validate the Mindful Reappraisal of Pain Sensations Scale (MPRS). Methods After item generation, we conducted exploratory and confirmatory factor analyses of the MRPS in samples of opioid-treated chronic pain patients both before (n=450; n=90) and after (n=222) participating in Mindfulness-Oriented Recovery Enhancement (MORE). We then examined the convergent and divergent validity of the MRPS. Finally, in data from a randomized clinical trial (n=250), the MRPS was tested as a mediator of the effects of MORE on reducing chronic pain severity. Results Exploratory and confirmatory factor analyses demonstrated the single-factor structure of the MRPS. The MRPS also evidenced convergent and divergent validity. Mindfulness training through MORE significantly increased MRPS scores relative to supportive psychotherapy (F4,425.03 = 16.15, p < .001). Changes in MRPS scores statistically mediated the effect of MORE on reducing chronic pain severity through 9-month follow-up. Conclusions Taken together, these studies demonstrate that the MRPS is a psychometrically sound and valid measure of novel analgesic mechanisms of mindfulness including attentional disengagement from affective pain appraisals and interoceptive exposure to pain sensations.
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Affiliation(s)
- Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah
- Veterans Health Care Administration VISN 19 Whole Health Flagship site located at the VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - R. Lynae Roberts
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah
| | - Adam W. Hanley
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah
| | - Fadel Zeidan
- Department of Anesthesiology, University of California San Diego
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University
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14
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Chronic pain acceptance: Relations to opioid misuse and pain management motives among individuals with chronic low back pain. Addict Behav 2023; 136:107495. [PMID: 36156453 PMCID: PMC10187546 DOI: 10.1016/j.addbeh.2022.107495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/02/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
The opioid epidemic is a significant public health concern, and opioid consumption rates and opioid-related deaths are on the rise. Chronic pain acceptance, or willingness to experience pain and pain-related distress, is one pain-related psychological mechanism that may reduce maladaptive attempts to avoid or control pain using opioids among individuals with chronic lower back pain (CLBP). However, little work has examined chronic pain acceptance as it relates to opioid use and motives for use among adults with CLBP. The current investigation sought to explore the effects of chronic pain acceptance on opioid misuse and motives for opioid use (i.e., pain management and coping motives) among adults with CLBP. Participants were 291 adults (69.1 % female, Mage = 45.77 years, SD = 11.22) self-reporting current mild to severe CLBP and current opioid use who were recruited via an online survey. Results indicated that higher acceptance of pain was related to lower levels of opioid misuse and lower motivation to use opioids to cope with pain. Contrary to hypotheses, chronic pain acceptance did not predict motivation to use opioids to cope with emotional distress (i.e., coping motives). The current findings provide support for chronic pain acceptance as a potential protective mechanism in terms of opioid misuse and motivation to use opioids to manage pain.
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15
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Moitra E, Stein MD, Busch AM, Pinkston MM, Abrantes AM, Baker JV, Weisberg RB, Anderson BJ, Uebelacker LA. Acceptance of chronic pain in depressed patients with HIV: correlations with activity, functioning, and emotional distress. AIDS Care 2022; 34:1338-1346. [PMID: 34554879 PMCID: PMC8940733 DOI: 10.1080/09540121.2021.1981819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/09/2021] [Indexed: 01/26/2023]
Abstract
Chronic pain is highly prevalent among persons with HIV (PWH), as is depression. Both comorbidities might contribute to, as well as be maintained by, avoidance-based coping. A promising alternative to avoidance-based coping is acceptance. Acceptance of pain is associated with improved functioning and quality of life in chronic pain patients, but this relationship has not been substantially explored among PWH. Cross-sectional data from 187 adult outpatients enrolled in a randomized trial for depressed PWH with chronic pain were analyzed. Controlling for pain severity and demographics, the relationships among pain acceptance and indicators of activity, functioning, and emotional distress (i.e., anxiety and anger) were assessed in seven regression models. No significant relationships were found between self-reported physical activity or objective measurement of mean steps/day with pain acceptance. Results revealed an inverse relationship between chronic pain acceptance and pain-related functional interference (by.x = -.52, p < .01) and a positive relationship with self-reported functioning (by.x = 7.80, p < .01). A significant inverse relationship with anxiety symptoms (by.x = -1.79, p < .01) and pain acceptance was also found. Acceptance of chronic pain can facilitate decreased emotional distress, improved well-being, and better functioning and quality of life. Further investigation of chronic pain acceptance among PWH could inform the development of acceptance-based interventions.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Michael D. Stein
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston MA, USA
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis MN, USA
- Department of Medicine, University of Minnesota - Twin Cities, Minneapolis MN, USA
| | - Megan M. Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Lifespan Physicians Group, The Miriam Hospital, Providence RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Jason V. Baker
- Department of Medicine, Hennepin Healthcare, Minneapolis MN, USA
- Department of Medicine, University of Minnesota - Twin Cities, Minneapolis MN, USA
| | - Risa B. Weisberg
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Bradley J. Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Psychosocial Research, Butler Hospital, Providence RI, USA
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16
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Kruger E, Ashworth J, Sowden G, Hickman J, Vowles KE. Profiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain. THE JOURNAL OF PAIN 2022; 23:1894-1903. [PMID: 35764256 DOI: 10.1016/j.jpain.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
Abstract
Pain acceptance and values-based action are relevant to treatment outcomes in those with chronic pain. It is unclear if patterns of responding in these two behavioral processes can be used to classify patients into distinct classes at treatment onset and used to predict treatment response. This observational cohort study had two distinct goals. First, it sought to classify patients at assessment based on pain acceptance and values-based action (N = 1746). Second, it sought to examine treatment outcomes based on class membership in a sub-set of patients completing an interdisciplinary pain rehabilitation program of Acceptance and Commitment Therapy for chronic pain (N = 343). Latent profile analysis was used in the larger sample to identify three distinct patient classes: low acceptance and values-based (AV) action (Low AV; n = 424), moderate acceptance and values-based action (Moderate AV; n = 983) and high acceptance and values-based action (High AV; n = 339). In the smaller treated sample, participants in the Low AV and Moderate AV class demonstrated improvements across all outcome variables, whereas those in the High AV class did not. These findings support the role of pain acceptance and values-based action in those with chronic pain.
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Affiliation(s)
- Eric Kruger
- The University of New Mexico Health Sciences Center, School of Medicine, Department of Orthopedics and Rehabilitation, Division of Physical Therapy.
| | - Julie Ashworth
- Impact Community Pain Service, Midlands Partnership Foundation NHS Trust; Primary Care Centre Versus Arthritis, School of Medicine, Keele University
| | - Gail Sowden
- School of Primary, Community & Social Care, Keele University; Connect Health, Newcastle upon Tyne
| | - Jayne Hickman
- UK Pain Service, Sandwell and West Birmingham Hospitals NHS Trust
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast & the Centre for Chronic Pain Rehabilitation, Belfast Health and Social Care Trust
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17
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Walsh S, Moseley GL, Gray RJ, Gillam M, Gunn KM, Barker T, Tran K, Eshetie T, Jones M. Use of behavioural activation to manage pain: a systematic scoping review. BMJ Open 2022; 12:e056404. [PMID: 35649614 PMCID: PMC9161098 DOI: 10.1136/bmjopen-2021-056404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Behavioural activation (BA) is an effective treatment for depression; however, it is unclear if it can be used to manage pain. OBJECTIVES To conduct a scoping review of primary research that reported using BA to support people living with chronic pain to understand how BA had been used in relation to pain. In addition, we wanted to understand whether there were any reported changes in that pain, and how and who delivered BA. ELIGIBILITY CRITERIA Primary research published in English. SOURCES OF EVIDENCE We searched seven databases MEDLINE, Ovid Embase, Ovid Emcare, PsycINFO, CINAHL, Scopus and Web of Science, for primary research. No initial date limit was used with the date the searches were conducted used as the end date limit (1 July 2021). CHARTING METHODS A customised data extraction table was developed, piloted and used. RESULTS 551 papers were screened for inclusion, with 15 papers included in our review. Studies were conducted in North America and in Canada. These included three case studies, nine uncontrolled trials and three randomised controlled trials. Only two studies reported pain as the primary outcome. BA was applied across a range of pain related conditions. The dose of BA ranged from 3 to 16 sessions. Duration of treatment was 3 weeks to 12 months. Most studies reported reductions in pain following exposure to BA. CONCLUSION BA has the potential to reduce pain. Caution needs to be exercised in the interpretation of these findings as a high risk of bias was observed in most studies. High-quality research is required to test if BA is an effective intervention for chronic pain.
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Affiliation(s)
- Sandra Walsh
- Department of Rural Health, University of South Australian - Whyalla Campus, Whyalla Norrie, Barngarla Country, South Australia, Australia
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Richard John Gray
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
| | - Marianne Gillam
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
| | - Kate M Gunn
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Trevor Barker
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Kham Tran
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Tesfahun Eshetie
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Martin Jones
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
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18
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Yu L, McCracken LM, Scott W. Predictors of Outcomes Following Interdisciplinary Acceptance and Commitment Therapy for Chronic Pain: Profiling Psychological Flexibility. Eur J Pain 2022; 26:1448-1459. [PMID: 35536177 PMCID: PMC9543918 DOI: 10.1002/ejp.1972] [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] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/21/2022] [Accepted: 05/08/2022] [Indexed: 11/07/2022]
Abstract
Background Growing evidence demonstrates the benefit of acceptance and commitment therapy (ACT) for people with chronic pain. However, there remain people with chronic pain who do not benefit from ACT, and predicting treatment response is difficult. Aims This aim of this study was to investigate if baseline psychological flexibility (PF) profiles predict responses to an ACT‐based pain management programme. Methods Data from 415 participants attending an interdisciplinary pain management programme were included. Participants completed measures of PF processes and outcomes pre‐ and post‐treatment. Latent profile analysis was used to identify subgroups of participants based on their baseline PF scores. ANOVAs were conducted to compare subgroups of participants on outcome variables at baseline, and changes from pre‐ to post‐treatment. Results Three subgroups of participants were identified: (a) low PF, (b) low openness and (c) high awareness and action. The three subgroups significantly differed on all outcome measures at pre‐treatment, supporting the clinical relevance of these PF profiles. However, participants with different baseline PF profiles did not appear to differ in terms of changes in outcome variables. Conclusions People with chronic pain demonstrate different PF profiles, but appear to respond to ACT similarly regardless of these profiles. Future studies with a more individualized focus are needed to further understand which components of ACT work for whom on which outcome and how. Significance There remain people with chronic pain who do not benefit from acceptance and commitment therapy (ACT), and predicting treatment response is difficult. This is the first study to identify psychological flexibility (PF) profiles along multiple PF processes using latent class analysis, and the first longitudinal study to investigate PF profiles in relation to outcomes in ACT for chronic pain. The findings contribute to the understanding of theoretically consistent predictors of outcomes in ACT, which in turn can inform treatment development.
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Affiliation(s)
- Lin Yu
- Middlesex University, Department of Psychology, UK
| | | | - Whitney Scott
- INPUT Pain Management Unit, NHS Foundation Trust, Guy's and St Thomas, UK.,King's College London, Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, UK
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19
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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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20
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Schroeter AC, MacDonald DA, Scholten-Peeters GGM, Goubert L, Kendall E, Coppieters MW. Preferred self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. A modified Delphi study. PAIN MEDICINE 2022; 23:1891-1901. [DOI: 10.1093/pm/pnac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
The plethora of self-administered questionnaires to assess positive psychosocial factors complicates questionnaire selection. This study aimed to identify and reach consensus on the most suitable self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain.
Design
A three-round modified Delphi study.
Participants
Forty international experts.
Methods
In Round 1, the experts suggested questionnaires deemed appropriate to assess resilience, optimism, pain acceptance and/or social support. In Round 2, experts indicated whether they considered the suggested questionnaires to be suitable (Yes/No/Don’t know) to assess these psychosocial factors, taking into consideration content, feasibility, personal experience and the measurement properties which we provided for each questionnaire. Questionnaires that were considered suitable by the majority of experts (≥60%) were retained for Round 3. In Round 3, the suitability of each questionnaire was rated on a 0–10 Likert scale. Consensus was reached if ≥ 75% of experts rated the questionnaire ≥7.
Results
From the 67 questionnaires suggested in Round 1, one questionnaire could be recommended per domain. For resilience: Pain Resilience Scale; for optimism: Revised Version of the Life Orientation Test; for pain acceptance: 8-item and Revised Versions of the Chronic Pain Acceptance Questionnaire; for social support: Emotional Support Item Bank of the PROMIS tool. Consensus for these questionnaires was also reached in a sensitivity analysis which excluded the ratings of experts involved in the development, translation and/or validation of relevant questionnaires.
Conclusion
We advocate the use of these recommended questionnaires so data can be compared and pooled more easily.
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Affiliation(s)
- Andrea C Schroeter
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | - David A MacDonald
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | | | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane & Gold Coast, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
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21
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Georgopoulos V, Akin-Akinyosoye K, Smith S, McWilliams DF, Hendrick P, Walsh DA. An observational study of centrally facilitated pain in individuals with chronic low back pain. Pain Rep 2022; 7:e1003. [PMID: 35441119 PMCID: PMC9012603 DOI: 10.1097/pr9.0000000000001003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Central pain facilitation can hinder recovery in people with chronic low back pain (CLBP). Objectives The objective of this observational study was to investigate whether indices of centrally facilitated pain are associated with pain outcomes in a hospital-based cohort of individuals with CLBP undertaking a pain management programme. Methods Participants provided self-report and pain sensitivity data at baseline (n = 97) and again 3 months (n = 87) after a cognitive behavioural therapy-based group intervention including physiotherapy. Indices of centrally facilitated pain were pressure pain detection threshold, temporal summation and conditioned pain modulation at the forearm, Widespread Pain Index (WPI) classified using a body manikin, and a Central Mechanisms Trait (CMT) factor derived from 8 self-reported characteristics of anxiety, depression, neuropathic pain, fatigue, cognitive dysfunction, pain distribution, catastrophizing, and sleep. Pain severity was a composite factor derived from Numerical Rating Scales. Cross-sectional and longitudinal regression models were adjusted for age and sex. Results Baseline CMT and WPI each was associated with higher pain severity (CMT: r = 0.50, P < 0.001; WPI: r = 0.21, P = 0.04) at baseline and at 3 months (CMT: r = 0.38, P < 0.001; WPI: r = 0.24, P = 0.02). High baseline CMT remained significantly associated with pain at 3 months after additional adjustment for baseline pain (β = 2.45, P = 0.04, R 2 = 0.25, P < 0.0001). Quantitative sensory testing indices of pain hypersensitivity were not significantly associated with pain outcomes at baseline or at 3 months. Conclusion Central mechanisms beyond those captured by quantitative sensory testing are associated with poor CLBP outcome and might be targets for improved therapy.
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Affiliation(s)
- Vasileios Georgopoulos
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham BRC, University of Nottingham, Nottingham, United Kingdom
| | - Kehinde Akin-Akinyosoye
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Stephanie Smith
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Daniel F. McWilliams
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Paul Hendrick
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- Physiotherapy, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David A. Walsh
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham BRC, University of Nottingham, Nottingham, United Kingdom
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22
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Sjöberg V, Tseli E, Monnier A, Westergren J, LoMartire R, Äng BO, Hagströmer M, Björk M, Vixner L. Effectiveness of the eVISualisation of physical activity and pain intervention (eVIS) in Swedish Interdisciplinary Pain Rehabilitation Programmes: study protocol for a registry-based randomised controlled clinical trial. BMJ Open 2022; 12:e055071. [PMID: 35428627 PMCID: PMC9014054 DOI: 10.1136/bmjopen-2021-055071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Living with chronic pain often involves negative consequences. Interdisciplinary Pain Rehabilitation Programmes (IPRP) is considered superior to single-treatment measures in patients with chronic pain. Despite this, effects emerge suboptimal and more than 20% of patients deteriorate in patient-reported physical health outcomes after IPRP. A novel e-Health intervention, eVISualisation (eVIS) of physical activity and pain, was systematically developed to facilitate individualisation of physical activity levels. By adding elements of data collection, visualisation and communication of objectively measured physical activity and patient-reported outcomes (pain intensity, interference of pain, pharmaceutical consumption) to existing treatment modalities in IPRP, the IPRP team acquires prerequisites to adapt advice and physical activity prescriptions and to evaluate set activity goals. The overall aim is twofold. First, the aim is to evaluate the feasibility of the subsequent registry-based randomised controlled clinical trial (R-RCT). Second, the aim is to prospectively evaluate the effectiveness of the eVIS-intervention as a supplement to IPRP on our defined primary (physical health) and secondary outcomes. METHODS AND ANALYSIS In the R-RCT, recruitment of 400 patients with chronic pain will be performed at 15 IPRP units. A random allocation to either IPRP + eVIS or to control group that will receive IPRP only will be performed. Data from the initial 30 participants completing the study period (6 months) will be included in a pilot study, where key feasibility outcomes (recruitment, randomisation, implementation, treatment integrity, data collection procedure, preliminary outcome measures) will be evaluated. Outcome variables will be extracted from the web application Pain And TRaining ON-line (PATRON) and from six national registries. Multivariate statistics and repeated measure analyses will be performed. Quality-adjusted life years and incremental cost-effectiveness ratio will be calculated for cost-effectiveness evaluation. ETHICS/DISSEMINATION The Swedish Ethics Review Board granted approval (Dnr 2021/02109). Results will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05009459. Protocol V.1.
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Affiliation(s)
- Veronica Sjöberg
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Elena Tseli
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Andreas Monnier
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Military Academy Karlberg, Swedish Armed Forces, Solna, Sweden
| | - Jens Westergren
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Riccardo LoMartire
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Björn O Äng
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Mathilda Björk
- Department for Prevention, Rehabilitation, and Community Medicine, Division of Occupational Therapy, Institution of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Linda Vixner
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
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23
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Tanner J, Teerijoki-Oksa T, Kautiainen H, Vartiainen P, Kalso E, Forssell H. Health-related quality of life in patients with chronic orofacial pain compared with other chronic pain patients. Clin Exp Dent Res 2022; 8:742-749. [PMID: 35347879 PMCID: PMC9209794 DOI: 10.1002/cre2.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Health‐related quality of life (HRQoL) of orofacial pain patients is lower than that of the general population and impaired in multiple dimensions. The aim of the present study was to investigate HRQoL of orofacial pain patients in comparison with patients suffering from other chronic pain disorders. Materials and Methods One hundred and fifty‐one tertiary care facial pain patients (mean age, 50 years; standard deviation [SD], 15; 119 females), were compared with 312 other non‐cancer chronic pain patients (mean age, 46 years; SD, 13; 204 women), recruited from three multidisciplinary pain clinics in Finland. The groups were compared using the 15D, and pain‐related measures such as pain interference, pain acceptance, anxiety, depression, and sleep. Statistical comparisons between groups were done using t test, χ2 test, or analysis of covariance. Multivariate linear regression analysis was used to study whether pain‐related aspects influencing HRQoL are similar between the patient groups. Results The 15D score was significantly higher in facial pain patients (0.823; SD, 0.114) indicating better HRQoL in comparison with other chronic pain patients (0.732; SD, 0.107) (p < .001). The 15D profiles of studied populations resembled each other but orofacial pain patients showed significantly higher scores for most individual 15D dimensions. Dimensions regarding discomfort and symptoms and sleep were most affected in both groups. Orofacial pain patients showed less psychosocial disability and better acceptance of their pain. Pain acceptance was a weaker explanatory factor of HRQoL in orofacial pain patients. Conclusion Compared to other non‐cancer chronic pain, chronic pain in the orofacial area causes less impairment in HRQoL. Orofacial pain patients showed less psychosocial disability and better pain acceptance.
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Affiliation(s)
- Johanna Tanner
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland.,Department of Prosthetic Dentistry and Stomatognathic Physiology, University of Turku, Turku, Finland
| | - Tuija Teerijoki-Oksa
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Pekka Vartiainen
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, Division of Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eija Kalso
- Department of Anaesthesiology, Department of Pharmacology, Intensive Care and Pain Medicine, Helsinki University Hospital, SleepWell Research Programme University of Helsinki, Helsinki, Finland
| | - Heli Forssell
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland
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24
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Reed DE, Cobos B, Nagpal AS, Eckmann M, McGeary DD. The role of identity in chronic pain cognitions and pain-related disability within a clinical chronic pain population. Int J Psychiatry Med 2022; 57:35-52. [PMID: 33487093 DOI: 10.1177/0091217421989141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Chronic pain has a significant impact on functioning and results in the disruption of one's assumed life trajectory, potentially altering their self-perceived identity. The present research is designed to determine whether identity-related issues are associated with common chronic pain cognitions and pain-related disability, which may help inform understanding of clinical chronic pain populations. METHOD Ninety-eight adult chronic pain patients were assessed at a local pain clinic during a regularly scheduled appointment focusing on pain management. Multivariate hierarchal regression was used to determine whether issues related to identity and death anxiety were associated with pain catastrophizing, pain acceptance, and pain-related disability, above and beyond pain severity, fear-avoidance, and age. RESULTS Self-concept clarity was significantly related to pain catastrophizing and pain acceptance, above and beyond death anxiety, pain severity, fear-avoidance, and age. Death anxiety was associated with pain catastrophizing, pain acceptance, and pain-related disability above and beyond pain severity, fear-avoidance, and age. CONCLUSIONS To the best of our knowledge, the present study is the first examination of self-concept clarity and death anxiety as they relate to pain catastrophizing, pain acceptance, and pain-related disability. These descriptive results support the inclusion of identity and death anxiety within the pain experience and could serve as a foundation for future directions relevant to clinical applications.
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Affiliation(s)
- David E Reed
- Department of Psychiatry, University of Texas - Health Science Center at San Antonio, San Antonio, TX, USA
| | - Briana Cobos
- Department of Psychiatry, University of Texas - Health Science Center at San Antonio, San Antonio, TX, USA.,University of Texas at San Antonio, San Antonio, TX, USA
| | - Ameet S Nagpal
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Max Eckmann
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Donald D McGeary
- Department of Psychiatry, University of Texas - Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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25
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Gasslander N, Alfonsson S, Jackalin A, Tengberg C, Håkansson J, Huotari L, Buhrman M. Predictors of adherence to an internet-based cognitive behavioral therapy program for individuals with chronic pain and comorbid psychological distress. BMC Psychol 2021; 9:156. [PMID: 34641946 PMCID: PMC8507117 DOI: 10.1186/s40359-021-00663-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The burden caused by chronic pain is significant, affecting at least 10 percent of the world´s population. While internet-based treatments based on cognitive behavioral therapy (CBT) have been shown to be promising in this area, attrition levels vary significantly. The purpose of this study was to investigate predictor variables for participants' adherence to an internet-based CBT treatment for individuals with chronic pain as well as to investigate associations between adherence and treatment outcome. METHODS Data for this study was retrieved from a randomized controlled trial including 95 individuals with chronic pain who received internet-based CBT. Treatment adherence was studied through three outcome variables: treatment progress, treatment completion and exercise completion. The predictor variables were grouped into four clusters: background variables (age, gender, marital status, level of education, and typical computer usage); the second cluster included health status variables (sick leave, current psychiatric diagnosis, previous psychotherapy for pain, current pharmacological treatment, previous depression, current depression, and current depressive symptoms); the third cluster included pain-related variables (opioid medication, history of pain, and pain symptoms) and the fourth cluster included motivation variables (measured with treatment preference, treatment credibility, compliance to the treatment schedule and contact with the therapists). RESULTS Findings showed that treatment progress was predicted by higher treatment credibility at baseline, whereas participants who were behind schedule in the second week of the program finished fewer treatment modules. When analyzing each cluster of predictor variables separately, current depressive symptoms also predicted fewer completed treatment modules. Among the pain-related variables, higher pain acceptance was the only predictor for completing more treatment modules. Treatment completion (which in this study was defined as having completed at least 75% of treatment modules) was predicted by higher treatment credibility and fewer depressive symptoms at baseline, and was thus similar to the results regarding treatment progress. Finally, all adherence variables predicted the treatment outcome pain interference. CONCLUSIONS Low treatment credibility, depressive symptoms and falling behind the treatment schedule early on were the most important predictor variables for low treatment adherence, while a number of demographical and pain-related variables were not related to adherence. The results from this study may help clinicians identify patients who are less likely to complete, and thus benefit from, their pain treatment. Trial registration ClinicalTrials.gov NTC03316846.
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Affiliation(s)
- Nils Gasslander
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden.
| | - Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Amanda Jackalin
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Cecilia Tengberg
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Johanna Håkansson
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Linda Huotari
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
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26
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Rivano Fischer M, Schult ML, Löfgren M, Stålnacke BM. Do quality of life, anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive-behavioural therapy-based programmes. J Int Med Res 2021; 49:3000605211027435. [PMID: 34275375 PMCID: PMC8293856 DOI: 10.1177/03000605211027435] [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: 11/16/2022] Open
Abstract
OBJECTIVE Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive-behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes. METHODS We used a retrospective multicentre pretest-posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions. RESULTS Neither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres. CONCLUSIONS These findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.
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Affiliation(s)
- Marcelo Rivano Fischer
- Rehabilitation Medicine, Health Sciences Department, Lund University, Lund, Sweden.,Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden
| | - Marie-Louise Schult
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Monika Löfgren
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Britt-Marie Stålnacke
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
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27
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Jensen MP, Hakimian S, Ehde DM, Day MA, Pettet MW, Yoshino A, Ciol MA. Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions. Pain 2021; 162:2036-2050. [PMID: 33470745 PMCID: PMC8205936 DOI: 10.1097/j.pain.0000000000002201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
ABSTRACT The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Shahin Hakimian
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Melissa A Day
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Mark W Pettet
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Hiroshima University, Higashihiroshima, Japan
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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Sturgeon JA, Kraus SW. Resilience in Women's Sexual Pain After Female Genital Cutting: Adaptation Across Time and Personal and Cultural Context. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1891-1895. [PMID: 31482425 DOI: 10.1007/s10508-019-01536-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, 98105, USA.
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Cuesta-Vargas AI, Neblett R, Nijs J, Chiarotto A, Kregel J, van Wilgen CP, Pitance L, Knezevic A, Gatchel RJ, Mayer TG, Viti C, Roldan-Jiménez C, Testa M, Caumo W, Jeremic-Knezevic M, Nishigami T, Feliu-Soler A, Pérez-Aranda A, Luciano JV. Establishing Central Sensitization-Related Symptom Severity Subgroups: A Multicountry Study Using the Central Sensitization Inventory. PAIN MEDICINE 2021; 21:2430-2440. [PMID: 33118603 DOI: 10.1093/pm/pnaa210] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The goal of this study was to identify central sensitization-related symptom severity subgroups in a large multicountry sample composed of patients with chronic pain and pain-free individuals using the Central Sensitization Inventory (CSI). METHODS A large, pooled international (N = 8 countries) sample of chronic pain patients plus healthy subjects (total N = 2,620) was randomly divided into two subsamples for cross-validation purposes. First, a hierarchical cluster analysis (HCA) was performed using CSI item-level data as clustering variables (test sample; N = 1,312). Second, a latent profile analysis (LPA) was conducted to confirm the optimal number of CSI clusters (validation sample; N = 1,308). Finally, to promote implementation in real-world clinical practice, we built a free online Central Sensitization Inventory Symptom Severity Calculator. RESULTS In both HCA (N = 1,219 valid cases) and LPA (N = 1,245 valid cases) analyses, a three-cluster and three-profile solution, respectively, emerged as the most statistically optimal and clinically meaningful. Clusters were labeled as follows: (i) Low Level of CS-Related Symptom Severity, (ii) Medium Level of CS-Related Symptom Severity, and (iii) High Level of CS-Related Symptom Severity. CONCLUSIONS Our results indicated that a three-cluster solution clearly captured the heterogeneity of the CSI data. The calculator might provide an efficient way of classifying subjects into the cluster groups. Future studies should analyze the extent to which the CSI cluster classification correlates with other patient-reported and objective signs and symptoms of CS in patients with chronic pain, their associations with clinical outcomes, health-related costs, biomarkers, (etc.), and responsiveness to treatment.
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Affiliation(s)
- Antonio I Cuesta-Vargas
- Department of Physiotherapy of the Faculty of Health Science at the, University of Malaga, (IBIMA), Malaga, Spain.,Faculty of Health at the Queensland University of Technology, Brisbane, Australia
| | | | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Alessandro Chiarotto
- Department of Health Sciences, Amsterdam Movement Sciences Research Institute, VU University, Amsterdam, the Netherlands.,Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jeroen Kregel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Vrije Universiteit, Brussels, Belgium
| | - C Paul van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Transcare, Transdisciplinary Pain Center, the Netherlands
| | - Laurent Pitance
- Neuro Musculoskeletal Lab, Institute of Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.,Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Aleksandar Knezevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Robert J Gatchel
- Pain in Motion International Research Group, Vrije Universiteit, Brussels, Belgium.,Department of Psychology, College of Science, University of Texas, Arlington, Texas, USA
| | - Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Carlotta Viti
- FACEit, Italian Association of Integrated Therapy for Cervico-Cranio-Facial Pain and Dysfunction, Barlassina, Italy.,Department of Biomedical Sciences, University of Padova, Padova, Italy.,Studio Fisioterapico Viti, Bologna, Italy
| | - Cristina Roldan-Jiménez
- Department of Physiotherapy of the Faculty of Health Science at the, University of Malaga, (IBIMA), Malaga, Spain
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Laboratory of Pain and Neuromodulation at UFRGS, Porto Alegre, Brazil.,Pain and Anesthesia in Surgery Department, School of Medicine, UFRGS, Porto Alegre, Brazil
| | | | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Albert Feliu-Soler
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
| | - Adrián Pérez-Aranda
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
| | - Juan V Luciano
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
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Palaniappan U, Suganthi L, Shagirbasha S. Building a yardstick–a benchmark framework for assessing higher education management institutions. BENCHMARKING-AN INTERNATIONAL JOURNAL 2021. [DOI: 10.1108/bij-07-2020-0383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHigher education management institutions play a vibrant role in imparting managerial skills to the students to face the corporate world. Performance evaluation of such institutions is mandate to ensure the outcome quality. To establish this, the present research explored the critical performance indicators of management institutions using the balanced scorecard (BSC) approach.Design/methodology/approachThis research explored the critical performance indicators of public, private and standalone management institutions in India. Data were collected from the representative sample of all the stakeholders in those management institutions. A specific vision was created and a systematic procedure was employed to arrive at the objectives, measures and metrics of the scorecard specific to the vision. Confirmatory factor analysis was used to perform analysis on the collected data. For the objectives and measures that evolved from confirmatory factor analysis, metrics were formulated based on the expert opinion.FindingsThe study resulted in 16 objectives, 46 measures and 54 metrics encompassing all the four perspectives of BSC. This paper has contributed a concrete, concise, comprehensive and context specific framework.Research limitations/implicationsThe nature of the BSC framework paves the way for continuous assessment and eventually helps the institutions to attain sustainable growth. This research contributes to the literature of balanced scorecard and also to the performance assessment of the management institutions.Originality/valueBSC-based benchmarking is a unique contribution to the academia of management education to precisely measure the performance of institutions. The model comprehensively includes the indicators from all the perspectives of stakeholders in terms of objectives, measures and metrics, thus proposing a holistic assessment.
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Aytur SA, Ray KL, Meier SK, Campbell J, Gendron B, Waller N, Robin DA. Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach. Front Hum Neurosci 2021; 15:587018. [PMID: 33613207 PMCID: PMC7892587 DOI: 10.3389/fnhum.2021.587018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Abstract
Over 100 million Americans suffer from chronic pain (CP), which causes more disability than any other medical condition in the United States at a cost of $560-$635 billion per year (Institute of Medicine, 2011). Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (CBT) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy (ACT) has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions (Gutierrez et al., 2004). However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women (n = 9) with chronic musculoskeletal pain. Functional magnetic resonance imaging (fMRI) data were collected pre- and post-ACT, and changes in functional connectivity (FC) were measured using Network-Based Statistics (NBS). Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire (AAQ-II), the Chronic Pain Acceptance Questionnaire (CPAQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the NIH Toolbox Neuro-QoLTM (Quality of Life in Neurological Disorders) scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection (default mode, DMN), emotion (salience, SN), and cognitive control (frontal parietal, FPN). These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies.
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Affiliation(s)
- Semra A. Aytur
- Department of Health Management and Policy, University of New Hampshire, Durham, NH, United States
| | - Kimberly L. Ray
- Department of Psychology, University of Texas at Austin, Austin, TX, United States
| | - Sarah K. Meier
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Jenna Campbell
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Barry Gendron
- Wentworth Health Partners Seacoast Physiatry, Somersworth, NH, United States
| | - Noah Waller
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Donald A. Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
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Ghorbani V, Zanjani Z, Omidi A, Sarvizadeh M. Efficacy of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer: a pre- and post-test clinical trial. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 43:126-133. [PMID: 34392667 PMCID: PMC8317551 DOI: 10.47626/2237-6089-2020-0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022]
Abstract
Objective: Breast cancer is the most common cancer in women worldwide. Many of these patients suffer from multiple psychological symptoms. The present study aimed to investigate the impact of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer. Methods: The present study was a pre- and post-test clinical trial with intervention and control groups. The research population consisted of women with breast cancer referred to the Ayatollah Yasrebi and Shahid Beheshti Hospitals in Kashan in 2018. Through a purposive sampling method, 40 women were selected and randomly divided into two groups, namely, intervention (n = 20) and control (n = 20). The applied tools included the Depression, Anxiety and Stress Scale (DASS-21), Chronic Pain Acceptance Questionnaire 8 (CPAQ-8), and Acceptance and Action Questionnaire - II (AAQ-II). Data were analyzed by SPSS 16 using descriptive statistics and analysis of variance (ANOVA). Results: The results showed that ACT treatment significantly reduced the mean scores of depression compared to the control group (F = 107.72, p < 0.001). The mean scores of pain acceptance (F = 9.58, p < 0.05) and psychological flexibility (F = 10.61, p < 0 .05) significantly increased in comparison with the control group. Conclusion: ACT can be considered as an effective therapeutic approach to reduce depression and increase pain acceptance and psychological flexibility in women with breast cancer. These changes appear to be due to improved acceptance of thoughts and feelings associated with cancer and increased psychological flexibility, which is the primary goal of ACT treatment. Clinical trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20190518043620N1.
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Affiliation(s)
- Vajiheh Ghorbani
- Department of Clinical Psychology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Zanjani
- Department of Clinical Psychology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Department of Clinical Psychology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mostafa Sarvizadeh
- Department of Medical Oncology, Kashan University of Medical Sciences, Kashan, Iran
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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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Vowles KE, Kruger ES, Bailey RW, Sowden G, Ashworth J, Hickman J, McCracken LM. Initial evaluation of the Chronic Pain Acceptance Questionnaire - 2. Eur J Pain 2020; 24:2027-2036. [PMID: 32816389 DOI: 10.1002/ejp.1650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/05/2022]
Abstract
Greater acceptance of chronic pain is associated with lesser levels of pain-related distress and disability and better overall functioning. Pain acceptance is most often assessed using the Chronic Pain Acceptance Questionnaire (CPAQ), which includes both an eight-item short form (CPAQ-8) and a twenty item parent measure (CPAQ-20). This study derived a two-item CPAQ for use in busy clinical settings and for repeated measurement during treatment, the CPAQ-2. An Item Response Theory (IRT) approach was used to identify the strongest items from the CPAQ-20, one from each of its two subscales. Next, regression analyses were conducted to evaluate the utility of the CPAQ-2 by examining variance accounted for in the CPAQ-8, CPAQ-20, and in measures of depression, pain-related fear, physical disability, and psychosocial disability. Four clinical databases were combined (N = 1,776) for the analyses. Items 9 and 14 were identified as the strongest CPAQ-20 items in the IRT analyses. The sum score of these two items accounted for over 60% of the variance in the CPAQ-8 and CPAQ-20. Furthermore, this score accounted for significant variance in measures of depression, pain-related fear, physical disability, and psychosocial disability after controlling for data collection method (i.e. in clinic or online), participant age, education, pain duration and usual pain. Finally, the amount of variance accounted for by the CPAQ-2 was comparable to that accounted for by both the CPAQ-8 and CPAQ-20. These results provide initial support for the CPAQ-2 and suggest that it is well-suited as a brief assessment of chronic pain acceptance. SIGNIFICANCE: The most frequently used measure of pain acceptance is the CPAQ, which includes both an eight-item short form, the CPAQ-8, and a longer twenty item parent measure, the CPAQ-20. The present study sought to derive a two-item measure of the CPAQ for use in busy clinical settings and for repeated measurement during treatment, the CPAQ-2. An IRT approach was used to identify the strongest items from the CPAQ-20, one from each of its two subscales in a large sample of 1,776 individuals with chronic pain. The two item measure accounted for significant variance in measures of depression, pain-related fear, physical disability, and psychosocial disability. The brief measure will be useful in assessing pain acceptance in busy clinical setting and longitudinal designs.
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Affiliation(s)
- Kevin E Vowles
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University - Belfast, Belfast, UK
| | - Eric S Kruger
- Division of Physical Therapy, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Robert W Bailey
- VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Gail Sowden
- IMPACT Pain Service, Midlands Partnership NHS Foundation Trust, National Health Service, Stoke-on-Trent, UK
| | - Julie Ashworth
- IMPACT Pain Service, Midlands Partnership NHS Foundation Trust, National Health Service, Stoke-on-Trent, UK
| | - Jayne Hickman
- IMPACT Pain Service, Midlands Partnership NHS Foundation Trust, National Health Service, Stoke-on-Trent, UK
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Terhorst Y, Baumeister H, McCracken LM, Lin J. Further development in the assessment of psychological flexibility: validation of the German committed action questionnaire. Health Qual Life Outcomes 2020; 18:260. [PMID: 32746838 PMCID: PMC7397648 DOI: 10.1186/s12955-020-01497-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 07/16/2020] [Indexed: 11/15/2022] Open
Abstract
Background Psychological flexibility is considered a fundamental aspect of health. It includes six interrelated facets: 1) cognitive defusion, 2) acceptance, 3) contact with the present moment, 4) self-as-context, 5) values, and 6) committed action. To gain further insight into psychological flexibility and its effects on health, reliable and valid instruments to assess all facets are needed. Committed action is one facet that is understudied. A long and short version of a validated measure (CAQ and CAQ-8) have been developed in English. Currently, there are no German versions of the CAQ. Aim of this study is to validate German-language versions of these in a chronic pain population. Methods The CAQ instructions and items were translated and evaluated in a chronic pain population (N = 181). Confirmatory factor analysis and Mokken scale analysis were conducted to evaluate the German questionnaires. Correlations with health outcomes, including quality of life (SF-12), physical and emotional functioning (MPI, BPI, PHQ-9, GAD-7), pain intensity, and with other facets of psychological flexibility (CPAQ, FAH-II) were investigated for convergent validity purposes. Scale reliability was assessed by the alpha, MS, lambda-2, LCRC, and omega coefficient. Results A bifactor model consisting of one general factor and two methodological factors emerged from the analysis. Criteria for reliability and validity were met. Medium to strong correlations to health outcomes and other facets of psychological flexibility were found. Results were similar to the original English version. Conclusions The present study presents a valid and reliable instrument to investigate committed action in German populations. Future studies could expand the present findings by evaluating the German CAQ versions in non-pain populations. The role of committed action and the wider psychological flexibility model in pain and other conditions deserves further investigation.
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Affiliation(s)
- Yannik Terhorst
- Department of Research Methods, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069, Ulm, Germany. .,Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Lance M McCracken
- Department of Psychology, Uppsala University, Box 1225 751 42, Uppsala, Sweden
| | - Jiaxi Lin
- Institute of Sport and Sport Science, University Freiburg, Schwarzwaldstraße 175, 79117, Freiburg, Germany
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Taheri AA, Foroughi AA, Mohammadian Y, Ahmadi SM, Heshmati K, Hezarkhani LA, Parvizifard AA. The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial. Diabetes Ther 2020; 11:1695-1708. [PMID: 32533548 PMCID: PMC7376796 DOI: 10.1007/s13300-020-00851-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Neuropathic pain is a complex phenomenon in patients with diabetes. These patients have many problems, such as psychological problems, high-level pain perception, and pain acceptance. This study aimed to evaluate the effectiveness of acceptance and commitment therapy on pain acceptance and pain perception in patients with painful diabetic neuropathy. METHODS This study was performed according to the clinical trial method. The sample size was 50 participants. In this study, participants were divided into interventional and control groups. According to the diagnosis of neurologists, all participants received conventional medications to manage neuropathic pain. The intervention group received acceptance and commitment therapy for eight sessions. The results in the three phases of pre-test, post-test, and follow-up were evaluated. After completing the study, to comply with ethical standards, the control group received psycho-education. The tools used were the McGill Pain Questionnaire (MPQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). Statistical analysis includes mean, standard deviation, and repeated-measures (ANOVA) conducted by SPSS software version 22. RESULTS The results demonstrated that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and reduce pain perception in the intervention group compared to the control group (P < 0.01). CONCLUSION The results indicated that acceptance and commitment therapy could be used as a psychological intervention besides pharmacotherapy to improve pain acceptance and reduce pain perception in patients with painful diabetic neuropathy. CLINICAL TRAIL REGISTRATION This study was registered at the Iranian Registry of Clinical Trials (IRCT20180205038630N4).
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Affiliation(s)
- Amir Abbas Taheri
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Foroughi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Youkhabeh Mohammadian
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Mojtaba Ahmadi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Khatereh Heshmati
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ali Akbar Parvizifard
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Lillis J, Thomas JG, Lipton RB, Rathier L, Roth J, Pavlovic J, O'Leary KC, Bond DS. The Association of Changes in Pain Acceptance and Headache-Related Disability. Ann Behav Med 2020; 53:686-690. [PMID: 30289426 DOI: 10.1093/abm/kay076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Migraine accounts for substantial suffering and disability. Previous studies show cross-sectional associations between higher pain acceptance and lower headache-related disability in individuals with migraine, but none has evaluated this association longitudinally during migraine treatment. PURPOSE This study evaluated whether changes in pain acceptance were associated with changes in headache-related disability and migraine characteristics in a randomized controlled trial (Women's Health and Migraine) that compared effects of behavioral weight loss (BWL) treatment and migraine education (ME) on headache frequency in women with migraine and overweight/obesity. METHODS This was a post hoc analysis of 110 adult women with comorbid migraine and overweight/obesity who received 16 weeks of either BWL or ME. Linear and nonlinear mixed effects modeling methods were used to test for between-group differences in change in pain acceptance, and also to examine the association between change in pain acceptance and change in headache disability. RESULTS BWL and ME did not differ on improvement in pain acceptance from baseline across post-treatment and follow-up. Improvement in pain acceptance was associated with reduced headache disability, even when controlling for intervention-related improvements in migraine frequency, headache duration, and pain intensity. CONCLUSIONS This study is the first to show that improvements in pain acceptance following two different treatments are associated with greater reductions in headache-related disability, suggesting a potential new target for intervention development. CLINICAL TRIALS INFORMATION NCT01197196.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Richard B Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology and the Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| | - Lucille Rathier
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital, Providence, RI, USA
| | - Julie Roth
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurology, Rhode Island Hospital, Providence, RI, USA
| | - Jelena Pavlovic
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology and the Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| | - Kevin C O'Leary
- Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
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Casey MB, Cotter N, Kelly C, Mc Elchar L, Dunne C, Neary R, Lowry D, Hearty C, Doody C. Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One-Year Follow-Up. Musculoskeletal Care 2020; 18:64-73. [PMID: 31967395 DOI: 10.1002/msc.1444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION There is growing evidence to support Acceptance and Commitment Therapy (ACT) in the management of chronic pain. However, there is a need for further research evaluating ACT combined with physical exercise, and few studies have assessed the long-term impact of this type of intervention. This case series reports on the acceptability and impact of an ACT-based multidisciplinary pain management programme on a range of health outcomes in both the short and long-term. METHODS Seventy-three participants completed an 8-week group-based, pain management programme. The programme combined weekly sessions of ACT with education and exercise classes. Self-report outcome measures were completed at baseline, post-intervention and at one-year follow-up. The measures assessed pain intensity and interference, psychological distress, self-efficacy, pain acceptance, values-based action, pain catastrophizing, fear avoidance and healthcare utilization. Pedometers were worn to objectively measure physical activity. Data were analyzed using linear mixed modelling. Ethical approval for this study was granted by the Mater Misericordiae University Hospital (MMUH) Institutional Review Board (Reference 1/378/1541). RESULTS Eighty-six percent of respondents reported being satisfied with the intervention. Improvements were observed in most of the self-report outcomes post-intervention and many changes were maintained at one-year. There was also a significant increase in average daily step-count. CONCLUSION A pain management programme combining ACT with exercise appears to be an acceptable treatment option for people with chronic pain. While improvements were observed in both the short and long-term, further fully powered RCTs with long-term follow-up are required to test the effectiveness of this type of intervention.
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Affiliation(s)
- Máire-Bríd Casey
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Niamh Cotter
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Caoimhe Kelly
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Lisa Mc Elchar
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Cian Dunne
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Rachel Neary
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Damien Lowry
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine Doody
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
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Sweeney L, Moss-Morris R, Czuber-Dochan W, Murrells T, Norton C. Developing a better biopsychosocial understanding of pain in inflammatory bowel disease: a cross-sectional study. Eur J Gastroenterol Hepatol 2020; 32:335-344. [PMID: 31851083 DOI: 10.1097/meg.0000000000001615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pain is frequently reported by patients with inflammatory bowel disease (IBD). Pain in IBD is not fully explained by disease activity or other clinical findings, and a recent systematic review suggested that psychosocial factors have an important role in IBD-pain. The aim of this study was to investigate psychosocial factors associated with pain in IBD. METHODS 297 adults (>16 years) with IBD were recruited from outpatient clinics (n = 114) and online (n = 183). Participants completed validated questionnaires assessing pain and potential emotional, cognitive and behavioural correlates. Socio-demographic and clinical factors including disease activity were also recorded. RESULTS 243 (81.8%) of participants reported pain. Of these 243, mean age was 36 years; 153 (63%) had Crohn's disease, 90 (37%) had ulcerative colitis, and 165 (67.9%) were female. 62.6% reported mild, 31.6% moderate and 5.8% severe pain. 40.3% of participants with pain met established criteria for chronic pain and 18.5% reported opioid use. Female gender, smoking, surgery and steroid use were associated with greater pain severity. Psychosocial factors associated with pain-related interference included depression, catastrophising, fear avoidance, lower self-efficacy and worse mental well-being. Regression models explained 45.6% of the variance in pain severity and 49.7% of pain interference. Psychosocial factors explained 9.5% and 24% of this variance respectively when controlling for demographic and clinical variables. CONCLUSIONS Pain in IBD is significantly associated with cognitive and behavioural factors as well as low mood. This study contributes to a biopsychosocial understanding of pain in IBD and identifies important targets for future interventions.
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Affiliation(s)
- Louise Sweeney
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care
| | | | | | - Trevor Murrells
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care
| | - Christine Norton
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care
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Li T, Liu Y, Sheng R, Yin J, Wu X, Xu H. Correlation Between Chronic Pain Acceptance and Clinical Variables in Ankylosing Spondylitis and Its Prediction Role for Biologics Treatment. Front Med (Lausanne) 2020; 7:17. [PMID: 32083089 PMCID: PMC7005047 DOI: 10.3389/fmed.2020.00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/13/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives: Studies have proven that improving patients' acceptance of chronic pain could be an effective therapy for alleviating pain and other symptoms. Our objectives were to investigate the correlation between chronic pain acceptance and clinical variables in ankylosing spondylitis (AS), and the prediction role of chronic pain acceptance for biologics treatment. Methods: First, 167 AS patients were recruited to complete a series of questionnaires, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Chronic Pain Acceptance Questionnaire (CPAQ), Hospital Anxiety and Depression Scale (HADS), and Tampa Scale for Kinesiophobia (TSK). Bivariate correlation analysis was utilized to investigate the correlation between pain acceptance and clinical variables. Based on the level of chronic pain acceptance and serum C-reactive protein (CRP), patients were separated into four subgroups. Then, another 68 patients initiating anti-tumor necrosis factor (TNF) treatment were recruited to complete the questionnaires at baseline (T0) and 3 months after treatment (T3). The changes in clinical variables and treatment response were compared between multiple subgroups. Results: Chronic pain acceptance had strong correlations with anxiety, depression and fear of movement, and moderate correlations with BASFI and pain intensity. Both activity engagement (AE) and pain willingness (PW) had significant correlations with pain intensity, BASFI and psychological status. In addition, AE had a significant correlation with disease duration, while PW had a significant correlation with ASDAS-CRP. Subgroup analysis showed that patients with low chronic pain acceptance and high levels of serum CRP had the highest BASDAI. Among patients initiating anti-TNF treatment, those with high pain acceptance and high levels of serum CRP achieved the most obvious reduction in BASDAI after 3 months treatment. Conclusion: Pain acceptance is a new tool to assess pain in AS which may also reflect physical and psychological status. Clinicians should identify high-risk patients with low chronic pain acceptance and high levels of serum CRP, and give psychological and pharmacological intervention promptly. Moreover, the combination of baseline chronic pain acceptance and serum CRP level could be used to predict the treatment response in AS patients initiating biologics treatment.
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Affiliation(s)
- Ting Li
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yaqun Liu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rong Sheng
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Yin
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, China
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Gooding H, Stedmon J, Crix D. 'All these things don't take the pain away but they do help you to accept it': making the case for compassion-focused therapy in the management of persistent pain. Br J Pain 2020; 14:31-41. [PMID: 32110396 PMCID: PMC7026828 DOI: 10.1177/2049463719857099] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People with persistent pain are frequently offered a pain management programme (PMP) as part of their care plan. Cognitive behavioural therapy (CBT) principles often underpin PMPs and has a good evidence base; nevertheless, more recent systematic reviews have suggested that its effectiveness is limited. Compassion-focused therapy (CFT) is a form of 'third-wave CBT' that offers an alternative and complementary view of pain, encouraging the person to be alongside their experience of pain and respond to it using skills of compassion they have learnt. METHOD The current research explored the effectiveness of a 12-week CFT group for people who experience persistent pain. Research interviews explored CFT members' experiences of the CFT group. Feedback was collected on the facilitators' experience of running the group and questionnaire data collected on participants' mood, pain disability, acceptance of chronic pain and levels of self-criticism and self-reassurance. RESULTS Interviews were analysed using interpretative phenomenological analysis that revealed five master superordinate themes representative across all interviews. These were then triangulated with data from the questionnaires and facilitator feedback. CONCLUSION In people whose persistent pain was compounded by a significant psychological component, a CFT group approach helped reduce feelings of isolation, improve ability to self-reassure, learn new ways of coping and develop a growing acceptance of the limitations associated with their pain. The possible implications for future clinical practice are considered.
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Affiliation(s)
- Hannah Gooding
- Children’s Psychological Health and Wellbeing Team, Level 12, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Plymouth University, Plymouth, UK
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Veillette J, Martel ME, Dionne F. A randomized controlled trial evaluating the effectiveness of an acceptance and commitment therapy-based bibliotherapy intervention among adults living with chronic pain. Can J Pain 2019; 3:209-225. [PMID: 35005411 PMCID: PMC8730660 DOI: 10.1080/24740527.2019.1678113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Chronic pain has a significant impact on the physical and psychological functioning of those living with this condition. It is now recognized that acceptance and commitment therapy (ACT) is an effective intervention in managing chronic pain; however, several barriers limit its accessibility. Aims: The current study aimed to evaluate the effectiveness of an 8-week bibliotherapy-type self-administered psychological intervention with minimal therapeutic contact, based on ACT, in the management of chronic pain. Methods: This was a randomized controlled trial with three measurement periods (pretest, posttest, and 3 months after the intervention; ClinicalTrials.gov Identifier: NCT03924687). A total of 140 adults with chronic pain were randomly assigned to an ACT self-help condition or a wait-list control condition. Results: Two-way repeated measures analysis of variance (ANOVA) models showed statistically significant differences between pretest and posttest in terms of pain-related disability (main variable), depression (secondary variable), pain-related acceptance, and psychological inflexibility (d = 0.46–0.88) in favor of the ACT self-help condition. At the 3-month follow-up, these differences were maintained and nearly 54% of participants reported an overall improvement of their physical and mental health. Conclusion: These results suggest that a psychological intervention self-administered through ACT bibliotherapy with minimal therapeutic support can improve the physical and emotional functioning of adults from the community who live with chronic pain.
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Affiliation(s)
- Josée Veillette
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Quebec and Pain Research Network (QPRN), Montreal, Quebec, Canada
| | - Marie-Eve Martel
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Quebec and Pain Research Network (QPRN), Montreal, Quebec, Canada
| | - Frédérick Dionne
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Quebec and Pain Research Network (QPRN), Montreal, Quebec, Canada
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Cutoff scores for the 8-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8) to identify different profiles of pain acceptance patterns, levels of function and behavioral flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Hadlandsmyth K, Dindo LN, Wajid R, Sugg SL, Zimmerman MB, Rakel BA. A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain. Psychooncology 2019; 28:2210-2217. [PMID: 31430830 DOI: 10.1002/pon.5209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Oncologic breast surgeries carry a risk for persistent postsurgical pain. This study was a randomized pilot and feasibility study of a single-session Acceptance and Commitment Therapy (ACT) intervention compared with treatment as usual among women undergoing surgery for breast cancer or ductal carcinoma in situ. METHODS Participants were recruited via letter of invitation and follow-up phone call from a single site in the United States from 2015 to 2017. Participants were at risk for persistent postsurgical pain, based on young age (<50), a preexisting chronic pain condition, or elevated anxiety, depression, or pain catastrophizing. RESULTS The 54 participants were female with a mean age of 52.91 years (SD=11.80). At 3-month postsurgery, 11% of the sample reported moderate-severe pain (>3 on a 0-10 numeric rating scale) in the operative breast or with arm movement. Written qualitative responses indicated that the majority of participants who received the intervention understood the concepts presented and reported continued practice of exercises learned in the session. The between group effect sizes for moderate-severe pain and elevated anxiety at 3-month post-surgery were small (Phi=0.08 and 0.16, respectively). The between group effect sizes for depression, pain acceptance, and pain catastrophizing at 3-month postsurgery were minimal. CONCLUSIONS This study found small positive effects on postsurgical pain and anxiety for a single-session ACT intervention among women with breast cancer. This study supports the use of ACT with this population.
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Affiliation(s)
- Katherine Hadlandsmyth
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Lilian N Dindo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Center for Innovations, Quality, and Effectiveness, Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas
| | - Roohina Wajid
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Sonia L Sugg
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Mun CJ, Beitel M, Oberleitner L, Oberleitner DE, Madden LM, Bollampally P, Barry DT. Pain catastrophizing and pain acceptance are associated with pain severity and interference among methadone-maintained patients. J Clin Psychol 2019; 75:2233-2247. [PMID: 31454081 DOI: 10.1002/jclp.22842] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The present study examined whether pain catastrophizing and pain acceptance, two important targets of psychosocial interventions for chronic pain, are uniquely associated with pain severity and pain interference among patients on methadone maintenance treatment (MMT). METHOD A total of 133 MMT patients who reported experiencing some pain during the previous week completed a battery of self-report measures. Multiple regression was used to test whether pain catastrophizing and pain acceptance are related to pain severity and pain interference above and beyond covariates including demographics, emotional distress, and current methadone dose. RESULTS Both pain acceptance and catastrophizing were significantly associated with pain severity and pain interference while controlling for covariates. CONCLUSIONS Consistent with previous literature on patients with chronic pain but without opioid use disorder, our findings suggest that both pain catastrophizing and pain acceptance are potentially important intervention targets among MMT patients with co-occurring opioid use disorder and chronic pain.
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Affiliation(s)
- Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut
| | - Lindsay Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut
| | - David E Oberleitner
- APT Foundation, Inc, New Haven, Connecticut.,Department of Psychology, University of Bridgeport, Bridgeport, Connecticut
| | - Lynn M Madden
- APT Foundation, Inc, New Haven, Connecticut.,Department of Internal Medicine-AIDS, Yale School of Medicine, New Haven, Connecticut
| | - Pooja Bollampally
- APT Foundation, Inc, New Haven, Connecticut.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
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Pain interference type and level guide the assessment process in chronic pain: Categorizing pain patients entering tertiary pain treatment with the Brief Pain Inventory. PLoS One 2019; 14:e0221437. [PMID: 31430355 PMCID: PMC6701883 DOI: 10.1371/journal.pone.0221437] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022] Open
Abstract
Chronic pain patients enter treatment with different problem profiles making careful assessment a necessity for more individualized treatment plans. In this cross-sectional study we assigned 320 patients entering tertiary multidisciplinary pain treatment into four categories based on whether they scored low or high on the activity and the affective pain interference dimensions of the Brief Pain Inventory (BPI). To determine whether this categorization system delineates issues that should be assessed further, the categories were compared with ANOVA and MANOVA analyses on three domains: variables affecting physical well-being (body mass index, exercise, substance use), psychological resources (mood), and pain-specific psychological factors (pain anxiety, pain acceptance). The results indicated that subjects who scored low on both interference dimensions compared similarly in weight: mean Body Mass Index (BMI) 27.0 (SD 6.0) kg/m2, and exercise: mean of 2.4 (SD 1.7) exercising sessions over 20 minutes per week, to the general population, had no depressive symptoms on average: mean Beck Depression Index II (BDI-II) score 11.7 (SD 7.5), and had the most favorable psychological reactions to pain relative to the other categories: mean total Pain Anxiety Symptoms Scale-20 (PASS-20) score 36.4 (SD 17.9). In contrast, when interference was high on activity, more physical well-being problems were evident e.g. weight: mean BMI 31.0 (SD 7.3) kg/m2, diminished exercise: mean of 1.5 (SD 1.6) exercising sessions per week, and avoidance behavior: mean PASS-20 Escape/Avoidance subscale 3.7 (95% CI: 1.7 to 5.8) scores higher in comparison to activity interference remaining low. With high affective interference, more depressive symptoms: mean BDI-II score 17.7 (SD 7.3), and more cognitive pain anxiety: mean PASS-20 Cognitive Anxiety subscale 2.8 (95% CI 0.7 to 4.8) scores higher in comparison to affective interference remaining low, emerged. Having high interference on both dimensions indicated accumulated risks for reduced physical well-being: mean BMI 29.9 (SD 6.1) kg/m2, mean of 1.2 (SD 1.7) exercising sessions per week, mood problems: mean BDI-II 20.3 (SD 10.6), and negative psychological reactions to pain: mean total PASS-20 score 53.2 (18.4). The results suggest that low interference on both dimensions may allow assessment with only physician consultations, while high interference on either dimension may call attention to distinct issues to be addressed with the help of a physiotherapist or a psychologist, whereas high interference on both dimensions highlights the need for a full multidisciplinary assessment.
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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: 13] [Impact Index Per Article: 2.6] [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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Baert F, Miller MM, Trost Z, Hirsh AT, McParland J, De Schryver M, Vervoort T. Parental Injustice Appraisals in the Context of Child Pain: Examining the Construct and Criterion Validity of the IEQ-Pc and IEQ-Ps. THE JOURNAL OF PAIN 2019; 21:195-211. [PMID: 31325647 DOI: 10.1016/j.jpain.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/22/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023]
Abstract
A growing pediatric and adult literature highlights the role of injustice appraisals in adjustment to pain. However, interpersonal injustice dynamics have remained largely unexplored. The present study investigated the factor structure and criterion validity of parentally adjusted versions of the Injustice Experience Questionnaire, assessing child-oriented (IEQ-Pc) and self-oriented appraisals (IEQ-Ps) in the context of child pain. Participants were triads of healthy children (N = 407, Mage = 12) and both their parents and dyads of children with chronic pain (N = 319, Mage = 14) and 1 parent. In both samples, children completed measures of functional disability and quality of life (physical, emotional, social, and academic); parents completed the IEQ-Pc, IEQ-Ps, and a measure of parental catastrophizing about child pain. Across samples, a confirmatory oblique two-factor model (Severity/Irreparability-Blame/Unfairness) provided a better fit to the data compared to a one-factor model; nevertheless, the two-factor solution was considered suboptimal. A post hoc exploratory factor analysis consistently revealed 1 factor. In terms of criterion validity, the IEQ-Pc and IEQ-Ps demonstrated differential associations depending on the child's pain versus healthy status, independent of parental catastrophizing. Further, findings in the healthy sample indicated that fathers' self-oriented injustice appraisals related to lower child social function. In the clinical sample, parental child-oriented injustice appraisals related to greater child functional disability and lower physical, emotional, social, and academic function. Current findings support the unique role of parental injustice appraisals, assessed by the IEQ-Pc and IEQ-Ps, in understanding child pain, but also suggest these may only partially capture the phenomenology of parental injustice appraisals in the context of child pain. PERSPECTIVE: This manuscript presents an examination of the construct and criterion validity of 2 parentally adjusted versions of the Injustice Experience Questionnaire. These measures could be valuable tools for clinicians in examining how parents respond to their child's pain as it impacts both the child's life and the parents'.
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Affiliation(s)
- Fleur Baert
- Department of Experimental, Clinical, and Health Psychology, Ghent University, Ghent, Belgium.
| | - Megan Marie Miller
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana
| | - Zina Trost
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Todd Hirsh
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana
| | - Joanna McParland
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland
| | - Maarten De Schryver
- Department of Experimental, Clinical, and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental, Clinical, and Health Psychology, Ghent University, Ghent, Belgium
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Ong CW, Whicker JJ, Muñoz K, Twohig MP. Measuring psychological inflexibility in adult and child hearing loss. Int J Audiol 2019; 58:643-650. [DOI: 10.1080/14992027.2019.1630759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Clarissa W. Ong
- Department of Psychology, Utah State University, Logan, UT, USA
| | - John J. Whicker
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Karen Muñoz
- Department of Psychology, Utah State University, Logan, UT, USA
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