Perceived competence and trait anxiety as determinants of pain coping strategies

Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey

The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient's physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020-May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030-0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005-0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014-0.309) but not through fear of movement (β = 0.062, 95% PBCI = - 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure.

Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain

BACKGROUND

Cognitive functional therapy (CFT) has been shown to reduce pain and disability in people with chronic low back pain.

OBJECTIVES

The purpose of this study was to investigate participants' experience of CFT by comparing participants who reported differing levels of improvement after participation in CFT, potentially yielding insight into the implementation of this approach.

DESIGN

This was a noninterventional, cross-sectional, qualitative study with an interpretive description framework.

METHODS

Individuals who had participated in CFT in 2 physical therapy settings (in Ireland and Australia) were recruited through purposive sampling based on disability outcomes postintervention (n=9), and theoretical sampling (n=5). This sampling strategy was used to capture a range of participant experiences but was not used to define the final qualitative groupings. Semistructured interviews were conducted 3 to 6 months postintervention.

RESULTS

Three groups emerged from the qualitative analysis: large improvers, small improvers, and unchanged. Two themes encapsulating the key requirements in achieving a successful outcome through CFT were identified: (1) changing pain beliefs and (2) achieving independence. Changing pain beliefs to a more biopsychosocial perspective required a strong therapeutic alliance, development of body awareness, and the experience of control over pain. Independence was achieved by large improvers through newly cultivated problem-solving skills, self-efficacy, decreased fear of pain, and improved stress coping. Residual fear and poor stress coping meant that small improvers were easily distressed and lacked independence. Those who were unchanged continued to feel defined by their pain and retained a biomedical perspective.

CONCLUSIONS

A successful outcome after CFT is dependent on instilling biopsychosocial pain beliefs and developing independence among participants. Small improvers may require ongoing support to maintain results. Further study is needed to elucidate the optimal approach for those who were unchanged.

Risk Factors Linked to Psychological Distress, Productivity Losses, and Sick Leave in Low-Back-Pain Employees: A Three-Year Longitudinal Cohort Study

Background. Low back pain (LBP) is one of the most common health problems worldwide. Purpose. To investigate the link between baseline demographic and occupational, medical, and lifestyle data with following psychological and occupational outcomes in a large sample of employees with LBP over a 3-year period. Study Design. Three-year prospective cohort study. Methods. Italian-speaking employees (N = 4492) with a diagnosis of LBP were included. Screening at Time 1 was done in order to collect information about severity and classification of LBP, demographic, lifestyle, and occupational status data. Psychological distress (PGWBI) and occupational burden were assessed after 3 years. Results. After 3 years, employees with LBP not due to organic causes had an increased risk of psychological distress. Gender appears to be an important variable for following occupational burden. Indeed, being a white-collar man with a LBP without organic causes seems to be a protective factor for following work outcomes, while being a white-collar woman with a LBP not due to organic causes appears to be a risk factor for subsequent sick leave. Moreover, LBP severity affects psychological and occupational outcomes. Conclusion. Our findings have several implications that could be considered in preventive and supportive programs for LBP employees.

Muscle Mass Index and Animal Source of Dietary Protein Are Positively Associated with Insulin Resistance in Participants of the NuAge Study

OBJECTIVES

Contribute evidence towards the complex interrelationships of body composition, insulin sensitivity and protein intake independently from adiposity in an older population.

DESIGN

This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis.

SETTING

The loss of muscle mass has been implicated in the development of insulin resistance. We propose to test associations of muscle mass with insulin sensitivity and their respective associations with animal and vegetable sources of protein intake, independently from adiposity.

PARTICIPANTS

Non-diabetic participants aged 68-82 years from the NuAge study with all available measures (n=441) were included.

MEASUREMENTS

A model considering age, sex, chronic diseases, physical activity; smoking and sources of protein intake influencing body composition components and insulin sensitivity was created and tested with Path Analysis for their independent associations. Muscle mass index (MMI; kg/height in m2) and % body fat were derived from DXA and BIA. Insulin resistance was estimated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score and physical activity by the Physical Activity Scale for the Elderly (PASE) questionnaire. Protein intakes were obtained from three non-consecutive 24h-diet recalls.

RESULTS

In the final model, direct positive associations were observed between HOMA-IR score and MMI (ß=0.42; 95%CI: 0.24; 0.6) and % body fat (ß=0.094; 95%CI: 0.07; 0.11). There were no direct associations between animal protein intake and MMI or with HOMA-IR. There was a significant direct negative association between plant protein intake and MMI (ß= -0.068; 95%CI: -0.13; -0.003) and significant indirect associations mediated through MMI and % body fat between HOMA-IR and animal protein intake (ß=0.0321; 95%CI: 0.01; 0.05), as well as plant protein intake (ß= -0.07; 95%CI: -0.1; 0.0).

CONCLUSIONS

Our final model indicated that MMI and HOMA score were significantly positively associated. Protein intake sources were related to HOMA-IR score differently through MMI and % body fat, respectively.

Interrelated factors favoring physical performance and activity in older adults from the NuAge cohort study

OBJECTIVES

Contribute evidence towards the complex interrelationships of body composition, physical performance and physical activity (PA) in an older population to assist in decisions for maintaining functional capacity in older adults.

DESIGN

This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis. A proposed model with age, sex, energy intake and chronic diseases as predictors associated with body composition components, while the latter associated with physical performance and with PA acting both as a predictor and as an outcome of physical performance.

PARTICIPANTS

A sample of 847, community dwellers, non-diabetic older men and women from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge Study).

MEASUREMENTS

Physical performance tests were reduced to two indices: strength and mobility. Muscle mass index (MMI; kg/height(2)) and % body fat were derived from DXA and bioimpedance analysis (BIA). PA was assessed by the Physical Activity Scale for the Elderly (PASE) and energy intakes were calculated from 24-hour food recalls. Data from the NuAge dataset served to test the relationships. The proposed model was evaluated using indices of fit.

RESULTS

Significant associations were found for MMI and % body fat with mobility (β -0.11 and -0.02, respectively), and for MMI with strength (β=0.60). PA was associated with MMI (β=0.02) and negatively with % body fat (β=-0.16), while mobility associated with PA (β=0.65). Our hypothesized model, with some paths added, fit the data: chi-square=4.64, root mean square error of approximation (RMSEA)=0.

CONCLUSIONS

PA has desirable associations with body composition in older adults and mobility is associated with PA. These results stress the importance of taking into account the prior level of mobility when recommending PA for this age group. This model could explain in part the complex interrelationships that occur with aging and the potential factors that could be targeted to assist older individuals in maintaining functional capacity.

Measures of anxiety: is there a difference in their ability to predict functioning at three-month follow-up among pain patients?

Independent investigators have found that pain is related to health anxiety, trait anxiety, pain-related anxiety, and anxiety sensitivity. To date, the relationship among these anxiety-related constructs has not been studied directly and little is known about their relative ability to predict adjustment to pain over time. This paper presents longitudinal data from measures given to 227 musculoskeletal pain patients. Patients were asked at the time of their first visit (T1) to a physiotherapy clinic to complete a questionnaire package including measures of these different forms of anxiety as well as pain severity, disability, negative affect, and perceived control. Approximately 3 months later (T2), 50% of patients responded to these same questionnaires. Results showed that correlations among the anxiety measures at T1 ranged from 0.35 to 0.56. Using multiple regression analyses, measures of T1 anxiety were each examined for their ability to predict unique variance in disability, negative affect, and perceptions of control measured at T1 and T2. At T1, after controlling for pain severity and other measures of anxiety, pain-related anxiety uniquely predicted both disability and negative affect, trait anxiety uniquely predicted negative affect and perceptions of control, and anxiety sensitivity uniquely predicted negative affect. At T2, after controlling for pain severity, other measures of anxiety and each respective measure of functioning at T1, health anxiety uniquely predicted disability and negative affect, although anxiety sensitivity also uniquely contributed to the prediction of negative affect. It is concluded that the importance of various forms of anxiety is dependent on the timeframe and outcome examined. Clinical implications of the findings as well as directions for future research are discussed.

Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospective study

Low back pain (LBP) is a major problem of public health. Chronic pain is the most difficult to treat and the most expensive. The way patients cope with their pain may influence its outcome.

AIM

To identify coping strategies of LBP patients, and their influence on LBP evolution.

METHODS

Ninety nine patients were assessed just after an acute LBP episode and one year later. Assessment tools included medical and social reports, scales of anxiety, depression, quality of life, locus of control (LOC), social support and coping strategies.

RESULTS

One year after the initial episode, 67% of patients have improved and 33% had a chronic pain. A principal components analysis showed that two main dimensions might be identified inside the outcome: functional and emotional non-adjustment. Functional non-adjustment was predicted by male gender, reduction of activity, and history of trauma over one year. Emotional non-adjustment was only predicted by trait-depression. Reactions to pain were structured in four factors: distraction-praying, helplessness-hopelessness, cognitive restructuration and perceived control. Two of these factors predicted adjustment one year later: distraction-praying had a direct effect on functional non-adjustment, and helplessness-hopelessness on emotional issue.

CONCLUSIONS

Besides somatic factors, psychosocial predictors of LBP chronic evolution may be identified. Both aspects must be taken into account in order to prevent chronic pain. Perhaps cognitive-behavior therapy may help LBP patients to cope with pain in a better way.

Cognitive-behavioural predictors of children's tolerance of laboratory-induced pain: implications for clinical assessment and future directions

This study sought to investigate cognitive-behavioural predictors of children's tolerance for laboratory-induced cold-pressor pain. It was hypothesised that pain tolerance, as measured by immersion time, would be greater in children who were high in self-efficacy for pain, high in self-reported use of cognitive-coping strategies, and low in emotion-focused coping strategies such as catastrophising. Age and sex differences were also examined in post hoc analyses. Children between the ages of 7 and 14 years (N = 53) participated in the study. Offering partial support for the hypotheses, use of cognitive distraction was found to be associated with greater pain tolerance, while use of internalising/catastrophising was associated with lower pain tolerance. Older boys tended to have greater pain tolerance than younger boys, whereas younger and older girls had intermediate pain tolerance levels. Self-efficacy for pain, in general, was found to be positively correlated with age. The results support efforts to identify children who, because they have lower confidence or lower skills in coping with distress, may need extra support and preparation for painful procedures. Further research is needed to investigate these findings within a clinical pain context.

The use of multivariate statistical methods in psychiatry

Multivariate methods such as factor analysis and cluster analysis have been used for many years by psychiatric researchers primarily for investigating the problems of psychiatric diagnosis. In more recent times, the range of multivariate techniques used has been extended as has the number of areas in which they are being applied.