Coping or acceptance: what to do about chronic pain?

Health locus of control and symptom distress: The mediating role of illness acceptance and symptom severity in acute leukemia patients

OBJECTIVE

This study aims to explore the multiple mediating roles of illness acceptance and symptom severity between health locus of control and symptom distress in acute leukemia patients.

METHODS

From June 2022 to March 2023, a convenience sampling method was used to recruit 208 acute leukemia patients in the inpatient center of a hospital in Hebei. The Chinese versions of Multidimensional Health Locus of Control Scale, Illness Acceptance Scale, and Anderson Symptom Assessment Scale was used in the cross-sectional study.

RESULTS

All participants reported the presence of symptom distress. Symptom distress was significantly correlated with chance health locus of control, illness acceptance, and symptom severity (P＜0.05). Illness acceptance alone played a mediating role in the relationship between chance health locus of control and symptom distress in acute leukemia patients (β=0.087, 95%CI 0.030-0.167). The indirect role of chance health locus of control on symptom distress through symptom severity alone was also statistically significant (β=0.131, 95%CI 0.008-0.252). Furthermore, the multiple mediating role of chance health locus of control and symptom distress through illness acceptance and symptom severity combined was verified (β=0.027, 95%CI 0.001-0.089). The alternative model is also valid, indicating bidirectional relationships between symptom severity, illness acceptance, and chance health locus of control, collectively influencing symptom distress.

CONCLUSION

There is a positive relationship between chance health locus of control and symptom distress; additionally, increasing social psychological interventions for illness acceptance and strengthening the management of core symptoms will help alleviate the impact of health chance locus of control on symptom distress in acute leukemia patients. Longitudinal studies are needed to confirm the causal relationships among the variables explored within the model.

IMPACT ON NURSING PRACTICE

It is recommended that healthcare professionals pay attention to the assessment of health locus of control in patients, identify patients with health chance locus of control in a timely manner, take measures to enhance their disease acceptance, and strengthen the management of core symptoms, thereby reducing their level of symptom distress.

Endometriosis: patient-doctor communication and psychological counselling

The fact that endometriosis is one of the most frequent gynaecological disorders in women and girls is gradually attracting greater public and political attention. There is also substantial awareness of the disorder among German gynaecologists, albeit without sufficient "equipment" for discussing the condition with patients and providing psychological counselling. This article offers hands-on proposals for medical counselling and the discussion of relevant issues, as well as other practical tips and suggested verbalisations for use by women suffering from endometriosis (and their partners). These practical recommendations will certainly help to improve the doctor-patient relationship in the case of endometriosis. The resources mentioned below (guidebooks, websites) focus on German-language offerings only.

Supportive care needs in predicting the acceptance of illness among gynecological cancer patients undergoing therapy: a cross-sectional study

PURPOSE

This study aimed to examine the effect of supportive care needs and related factors in the acceptance of illness by gynecological cancer patients undergoing therapy.

METHODS

A cross-sectional design was adopted. The study included 190 gynecologic cancer patients by convenience sampling method. The personal information form, Acceptance of Illness Scale, and Supportive Care Needs a Survey-Short Form were used for data collection. ANOVA, t-test, Pearson's correlation test, and hierarchical regression analysis were used for analyzing the data.

RESULTS

Most participants (72.6%) had moderate acceptance of illness, and the Supportive Care Needs a Survey-Short Form total score was a moderate level, at 84.93 ± 18.86. All the patients stated that their need for supportive care had caused them much concern, thus needing additional help. The acceptance of illness was negatively related to unmet supportive care needs (r =-0.515, p = 0.001) and all its subscales [health care service and informing, psychology, sexuality, daily life, (r = -0.343, r = -0.447, r = -0.341, r = -0.408, respectively; p < 0.05)]. Hierarchical regression analyses indicated unmet psychology (β = -0.305), daily life (β = -0.205) and sexuality needs (β = -0.167), perceived income (β = 0.290), and occupation (β = -0.167), explaining 45% of the acceptance of illness.

CONCLUSIONS

Acceptance of illness of gynecological cancer patients undergoing therapy needs to be improved. Perceived income and occupation are positive predictors, and unmet psychology, daily life, and sexuality needs are negative predictors of acceptance of illness.

Race, Ethnicity, and Belief in a Just World: Implications for Chronic Pain Acceptance Among Individuals with Chronic Low Back Pain

Chronic pain acceptance is a psychological process consistently linked with improved functional outcomes. However, existing research on this construct has not considered the role of racial or ethnic background, despite growing evidence of racialized disparities in pain experience and treatment. This study aimed to examine racial differences in chronic pain acceptance, as measured by the chronic pain acceptance questionnaires (CPAQ), in a multicultural sample of individuals with chronic low back pain (N = 137-37.2% White, 31.4% Hispanic, and 31.4% Black/African American). We further sought to examine moderating effects of discrimination, pain-related perceived injustice (PI), and just world belief (JWB). Analyses consisted of cross-sectional one-way analyses of variance with Bonferroni-corrected post hoc comparisons, followed by regression models with interaction terms, main effects, and relevant covariates. Results indicated higher scores on the CPAQ for White individuals compared to Black or Hispanic individuals. Significant interactions were noted between race/ethnicity and JWB in predicting pain acceptance, after controlling for demographic and pain-related variables, such that the positive association between JWB and pain acceptance was significant for White participants only. Race/ethnicity did not show significant interactions with PI or prior racial discrimination. Findings highlight racial differences in levels of chronic pain acceptance, an adaptive pain coping response, and a stronger JWB appears to have a positive impact on pain acceptance for White individuals only. Results further confirm that members of disadvantaged racial groups may be more susceptible to poorer pain adjustment, which is the result of complex, multi-level factors. PERSPECTIVE: This study identifies racial differences in levels of pain acceptance, an adaptive psychological response to chronic pain, such that White individuals with chronic low back pain demonstrate higher levels of pain acceptance. The article further explores the impacts of intrapersonal and sociocultural variables on racial differences in pain acceptance.

Experience of Disease Acceptance in Chinese Patients with Newly Diagnosed Crohn's Disease: A Descriptive Qualitative Study

Background

High levels of disease acceptance are important predictors of improved psychological well-being, treatment outcomes, and enhanced quality of life. Relatively few studies have focused on the process of disease acceptance in patients with Crohn's disease (CD), particularly those who are newly diagnosed.

Purpose

To explore the disease acceptance process in newly diagnosed CD patients.

Patients and Methods

A descriptive qualitative approach was employed. Sixteen CD patients from 2 tertiary hospitals in Hangzhou, Zhejiang were recruited through purposive sampling using a maximum variation strategy. Semi-structured interviews were conducted. The interviews were transcribed verbatim and analysed using conventional content analysis.

Results

Five phases of the psychosocial process of the "acceptance journey" of newly diagnosed CD patients emerged from the data analysis: (1) praying for the illness to not be CD; (2) not being able to accept CD; (3) having to accept CD; (4) knowing that CD should be acceptable; and (5) starting to accept CD. Patients at the stage of "starting to accept CD" are more proactive and motivated to face the disease, and their overall acceptance of the disease is higher than that of the previous stages. However, by the end of the interview, 2 patients remained at the stage of "having to accept CD", and 3 patients remained at the stage of "knowing that CD should be acceptable". Two patients entered the stage of "starting to accept CD" and then reverted back to one of the previous stages.

Conclusion

The "acceptance journey" of newly diagnosed CD patients is dynamic, individual and reversible. Traditional Chinese cultural values such as respect for authority, the philosophy of wu-wei and family responsibility contribute to the acceptance of CD in Chinese patients. Hence, there is a need to provide early and culturally tailored psychological support or interventions according to the stages of acceptance.

The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions

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.

Impact of Undergoing Thoracolumbar Surgery on Patient Psychosocial Profiles

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

Investigate the impact of thoracolumbar surgery on patients' psychosocial profiles.

METHODS

A prospective cohort study of thoracolumbar surgery patients (N = 177). Measures of interest collected at baseline and 24-months after surgery were: modified Oswestry Disability Index (mODI), Numerical Rating Scores for Back Pain (NRS-B), Leg Pain (NRS-L), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), Multidimensional Scale of Perceived Social Support (MSPSS), Mental Component Summary (MCS) and patient expectations for surgery impacts on mental well-being. Cohorts were separated based on attaining meaningful change defined as either 30% improvement or minimal scores in NRS-B, NRS-L and mODI. Mixed measures ANOVAs were run (α = .05).

RESULTS

Patients who showed meaningful change had significant improvements in PCS, TSK and CPAQ-8 scores but not in MSPSS scores. Patients had improvement in MCS scores over 24-months follow-up, but this change was not significantly different based on attainment of meaningful change. Overall, 75.9% of patients reported their mental well-being expectations were met. Patients who did not achieve meaningful change showed no change on any psychosocial measures with only 55.9% reporting their mental well-being expectations met.

CONCLUSION

Thoracolumbar surgery results in significant improvement of psychosocial variables for patients who experienced meaningful change for pain and disability. Worsening of psychosocial health was not evident in patients who did not attain meaningful change.

Perceived injustice and its impact on psychological distress in cancer patients and survivors

PURPOSE

Perceived injustice is a novel psychosocial construct that reflects negative cognitive appraisals of unfairness, externalized blame and the irreparability and severity of one's loss. Previous research has highlighted the negative impact of perceived injustice on recovery and mental health outcomes, particularly in pain-related samples. This study aimed to (i) explore the role of perceived injustice on psychological outcomes in a general cancer population and (ii) describe demographic and psychosocial characteristics associated with perceptions of injustice.

METHODS

The study employed a cross-sectional, observational design. Using a purposive convenience sampling technique, individuals that have or have had cancer completed an online survey assessing perceived injustice (IEQ), psychological distress (HADS), mental adjustment to cancer (Mini-MAC) and satisfaction with care (PSCC) (N = 121).

RESULTS

Levels of perceived injustice were high with 43.2% of the sample scoring in the clinical range. Hierarchical regression analyses showed that perceived injustice contributed unique variance to the prediction of anxiety and depression. Low satisfaction with care, being under the age of 40 and not having children were identified as significant predictors of perceived injustice. Satisfaction with care did not significantly moderate the association between perceived injustice and mental health outcomes but directly impacted anxiety levels.

CONCLUSION

Cancer patients reporting high levels of perceived injustice are at greater risk of feeling psychologically distressed. Prevention and management of injustice perceptions may require interventions targeting specific negative attributions, as well as cancer care in general. Further implications for healthcare practice are discussed.

Determinants of coping styles of people with Parkinson's Disease

Little is known about how people with Parkinson's disease (PD) cope with stressful life events. We examined the determinants of specific coping strategies and whether specific choices have any impact on quality of life (QoL). We recruited patients with PD who had been seen at a neurology outpatient clinic at least once during the past year as part of the PRIME-NL cohort study. Coping was measured using the Ways of Coping Questionnaire (WCQ) and QoL was measured using the Parkinson's Disease Questionnaire (PDQ-39). 977 out of 988 participants completed the questionnaires and 935 participants were diagnosed with PD. Factor analysis was undertaken to test if ways of coping were similar or different to previous findings in a PD population. We used linear regression analyses to examine predictors of coping styles. We then used multivariable linear regression to test how coping style was associated with the domains of QoL conditional on potential confounders. The five coping styles identified by the factor analysis were: "taking action and emphasizing the positive", "distancing and fantasizing", "goal oriented and planful problem solving", "seeking social support" and "avoidance and acceptance". Age, gender, education and anxiety were associated with the type of coping strategy. For example, higher education was associated with more active coping strategies (e.g. β = 4.39, p < 0.001 for goal oriented). Conditional on other confounders, most coping strategies had little effect on QoL domains. These findings demonstrate that coping behavior of people with PD is influenced by psychological status and personal traits. However, there was only a modest effect of coping behavior on QoL. Future research needs to test whether the enhancement or discouragement of certain coping strategies is feasible and can enhance QoL.

What Is Hidden behind Amputation? Quanti-Qualitative Systematic Review on Psychological Adjustment and Quality of Life in Lower Limb Amputees for Non-Traumatic Reasons

OBJECTIVE

This systematic review aims to investigate Quality of Life (QoL)/Health Related Quality of Life (HRQoL) and psychological adjustment in non-traumatic lower limb amputees (LLA).

METHODS

PubMed, Scopus, and Web of Science databases were used for the literature search. Studies were read and analysed using the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA statement procedure.

RESULTS

The literature search retrieved 1268 studies, of which 52 were included in the systematic review. Overall, psychological adjustment, especially depression with or without anxiety symptoms, influences the QoL/HRQoL in this clinical population. Other factors influencing QoL/HRQoL include subjective characteristics, physical aspects, the cause and level of the amputation, relational aspects, social support, and the doctor-patient relationship. In addition, the patient's emotional-motivational status, depression and/or anxiety symptoms, and acceptance play a key role in the subsequent rehabilitation process.

CONCLUSIONS

In LLA patients, psychological adjustment is a complex and multifaceted process, and QoL/HRQoL may be influenced by various factors. Shedding light on these issues may provide useful suggestions for promoting clinical and rehabilitative interventions that may be tailored and effective in this clinical population.

Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury

Background

Psychological distress after orthopaedic surgery can lead to worse outcomes, including higher levels of disability and pain and lower quality of life. The 10-item Optimal Screening for Prediction for Referral and Outcome-Yellow Flag (OSPRO-YF) survey screens for multiple psychological constructs relevant to recovery from orthopaedic injury and may be useful to preoperatively identify patients who may require further psychological assessment and possible intervention after surgery.

Purpose/Hypothesis

To determine the association between the OSPRO-YF and physiological patient-reported outcomes (PROs). It was hypothesized that higher OSPRO-YF scores (indicating worse psychological distress) would be associated with worse PRO scores at time of return to sport.

Study Design

Case series; Level of evidence, 4.

Methods

This study evaluated 107 patients at a single, academic health center who were assessed at a sports orthopaedics clinic and ultimately treated surgically for injuries to the knee, shoulder, foot, or ankle. Preoperatively, patients completed the OSPRO-YF survey as well as the following PRO measures: Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, numeric rating scale for pain; American Shoulder and Elbow Surgeons standardized shoulder assessment form for patients with shoulder injuries, the International Knee Documentation Committee score (for patients with knee injuries), and the Foot and Ankle Ability Measure (FAAM; for patients with foot or ankle injuries). At the time of anticipated full recovery and/or return to sport, patients again completed the same PRO surveys. Multivariable regression was used to evaluate the association between total OSPRO-YF score at baseline and PRO scores at the time of functional recovery.

Results

The baseline OSPRO-YF score predicted postoperative PROMIS Physical Function and FAAM Sports scores only. A 1-unit increase in the OSPRO-YF was associated with a 0.55-point reduction in PROMIS Physical Function (95% CI, -1.05 to -0.04; P = .033) indicating worse outcomes. Among patients who underwent ankle surgery, a 1-unit increase in OSPRO-YF was associated with a 6.45-point reduction in FAAM Sports (95% CI, -12.0 to -0.87; P = .023).

Conclusion

The study findings demonstrated that the OSPRO-YF survey predicts certain long-term PRO scores at the time of expected return to sport, independent of baseline scores.

Investigating the Relationship between Empowerment and Chronic Pain Acceptance and the Resulting Limitations in the Elderly with Diabetes living Southwest of Iran

BACKGROUND AIM

Considering the importance of pain acceptance in adjusting to chronic pain among diabetic patients, this study was conducted to determine the relationship between the empowerment scale and the level of chronic pain acceptance among the elderly with diabetes and the resulting limitations.

METHOD

This is a descriptive-analytical study on 250 older patients (65 years and older) with diabetes. The samples were selected through random convenience sampling, performed during 2019 to 2020 in the health centers of Ahvaz, Iran. The data were collected using the demographic information checklist and standard questionnaires including chronic pain acceptance questionnaire (CPAQ), the scale of chronic pain-related limitations, and the diabetes empowerment scale-short form (DES-SF). The data were analyzed using SPSS V24.

RESULTS

The majority of the samples were male (56%) and the mean age of the participants was 70.96 ± 8.95 years. The results showed that the mean and standard deviation were reported to be 20.04 ± 4.63 for pain acceptance, 46.16 ± 10.85 for chronic pain-related limitations, and 27.24 ± 9.65 for the empowerment scale. According to regression coefficients, the mean score of empowerments of patients with diabetes has no significant relationship with pain acceptance (p = .199, b = -0.327) and pain-related limitations (p = .925, b = 0.004).

CONCLUSIONS

Based on the results of this study, the level of empowerment, pain acceptance, and pain-related limitations in the older patients with diabetes was moderate and there was no significant relationship between them. Identifying vulnerable groups in the field of chronic pain and preventive, educational and therapeutic interventions will help increase patients' self-care capacity and reduce the limitations and the disability caused by pain.

Can we characterize A-P/IAP behavioural phenotypes in people with chronic pain?

Two behavioural phenotypes in healthy people have been delineated based on their intrinsic attention to pain (IAP) and whether their reaction times (RT) during a cognitively-demanding task are slower (P-type) or faster (A-type) during experimental pain. These behavioural phenotypes were not previously studied in chronic pain populations to avoid using experimental pain in a chronic pain context. Since pain rumination (PR) may serve as a supplement to IAP without needing noxious stimuli, we attempted to delineate A-P/IAP behavioural phenotypes in people with chronic pain and determined if PR can supplement IAP. Behavioural data acquired in 43 healthy controls (HCs) and 43 age-/sex-matched people with chronic pain associated with ankylosing spondylitis (AS) was retrospectively analyzed. A-P behavioural phenotypes were based on RT differences between pain and no-pain trials of a numeric interference task. IAP was quantified based on scores representing reported attention towards or mind-wandering away from experimental pain. PR was quantified using the pain catastrophizing scale, rumination subscale. The variability in RT was higher during no-pain trials in the AS group than HCs but was not significantly different in pain trials. There were no group differences in task RTs in no-pain and pain trials, IAP or PR scores. IAP and PR scores were marginally significantly positively correlated in the AS group. RT differences and variability were not significantly correlated with IAP or PR scores. Thus, we propose that experimental pain in the A-P/IAP protocols can confound testing in chronic pain populations, but that PR could be a supplement to IAP to quantify attention to pain.

Understanding pain related to adjuvant endocrine therapy after breast cancer: A qualitative report

OBJECTIVES

Most patients report pain while taking adjuvant endocrine therapy (AET) for the treatment of breast cancer. While studies have examined patients' experiences with side effects, none solely capture patients' experiences with AET-related pain, a troubling symptom that reduces quality of life and impairs treatment adherence. This study explored themes of AET-related pain to inform future intervention development.

METHODS

Between November 2017 and November 2018, female patients (n = 30) with early-stage breast cancer enrolled between 3 and 36 months post-initiation of AET. Purposeful sampling was stratified by adherence level, age, distress level and time taking AET. Study staff conducted, transcribed and coded semi-structured interviews via inductive thematic coding to identify pain-related themes and achieved high inter-coded reliability (Kappa = 0.96).

RESULTS

Several pain-related themes were observed. Attitudes around pain are generally negative, and management needs are largely unmet. Patients reported preferences for non-pharmacological management strategies and cited AET pain as a reason for medication breaks but not discontinuation. Patients within 19 months of starting AET and low adherers reported more intense and disruptive pain.

CONCLUSIONS

Patients' experiences varied by patient attributes and revealed modifiable factors that may be targeted through behavioural interventions. AET-related pain is a complex side effect for which psychosocial support may be beneficial.

“I had already tried that before going to the doctor” – exploring adolescents’ with knee pain perspectives on ‘wait and see’ as a management strategy in primary care; a study with brief semi-structured qualitative interviews

Objectives

The aim of this study was to examine how the “wait-and-see” recommendation affects adolescents’ understanding of their illness and symptoms and their care-seeking behavior.

Methods

This study included brief qualitative, semi-structured online interviews. Adolescents (age 10–19 years) with long-term knee pain, who had been recommended “wait-and-see” by their general practitioner (GP), were recruited via previous studies and social media. Two researchers conducted brief semi-structured interviews through Microsoft Teams. An interview guide with open questions was created prior to the interviews and updated as new questions emerged. The extracted data was transcribed and analyzed via a reflexive thematic approach in NVivo.

Results

Eight adolescents (mean age 17.8) with longstanding or recurrent knee pain (mean duration 3.5 years) were included. The analysis identified four main themes: (1) The perception of wait and see over time, (2) The GP’s acknowledgement and consideration, (3) experienced limitation from knee pain and (4) the importance of getting a diagnosis. The perception of “wait-and-see” approach changed from positive to negative when adolescents received the recommendation multiple times. Adolescents experienced frustration with their situation and a lack of consideration from their GP made them cautious about seeking additional care. Knee pain significantly limited the adolescents’ physical-and social activities. Receiving a diagnosis was important and helped adolescents dealing with their pain.

Conclusions

The connotation of wait-and-see changed from positive to negative for adolescents when receiving the recommendation multiple times. The participants felt getting a clinical diagnosis was a relief. Furthermore, the lack of consideration and acknowledgement from the GP plays an essential role in the adolescent’s understanding of their knee pain.

Implications

Recommending adolescents to “wait-and-see” multiple times in relation to their knee problems can lead adolescents experience frustration and a lack of consideration from their GP. It would be advisable for GPs to provide adolescents with a diagnosis as it can facilitate them in dealing with their pain and to use simple language when explaining adolescents their condition to improve communication.

Acceptance of chronic pain in depressed patients with HIV: correlations with activity, functioning, and emotional distress

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.

The Effects of Mindfulness Interventions on Fibromyalgia in Adults aged 65 and Older: A Window to Effective Therapy

Pain usually receives insufficient attention by individuals due to the misconception that pain is a natural consequence of aging. For persons aged 65 and older, a disease requiring further research is fibromyalgia, characterized by chronic pain without clear pathology. Mind-body therapies like mindfulness are beneficial for this population as they affect psychological and biological aspects of pain. These therapies emphasize a nonjudgmental acceptance of thoughts and attention to the experience without attempting to resist or change them. Despite the potential benefits of mindfulness interventions for persons with fibromyalgia aged 65 and older, only few studies have examined the effects of these therapies, yielding conflicting findings. Importantly, no study has yet to be conducted exclusively on this population. This comprehensive review examined existing literature focusing on the effects of mindfulness-based interventions on the physical and mental well-being of persons with fibromyalgia aged 65 and older. It highlights the need for further research on the relationship between mindfulness, fibromyalgia, and gerontology, calling for a standard protocol of intervention.

Usability Study of the iACTwithPain Platform: An Online Acceptance and Commitment Therapy and Compassion-Based Intervention for Chronic Pain

Background

This pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.

Methods

Seventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform’s usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner’s point of view.

Results

This study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.

Conclusion

This study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.

Incremental validity of acceptance over coping in predicting adjustment to endometriosis

Psychological acceptance has emerged as an important construct to explain low psychological distress in different clinical samples. However, the incremental validity of psychological acceptance to explain adjustment to medical conditions over other related and well-established constructs, such as coping, is relatively unclear. This study explored whether psychological acceptance significantly contributes to explain adjustment above and beyond coping in females with endometriosis. A total of 169 females (M_age = 34.95 years; SD_age = 6.07 years) with endometriosis and pain symptoms completed the Acceptance and Action Questionnaire-II, the Brief-COPE, the Hospital Anxiety and Depression Scale, the Psychological Wellbeing Scale, and the Endometriosis Health Profile-5. We conducted Hierarchical Regression Analyses to determine the contribution of psychological acceptance to explaining adjustment. The results showed that the contribution of psychological acceptance ranged from 11 to 20% when controlling for coping, while coping explained from 1 to 8% when the model was reversed. The findings suggest that psychological acceptance is a more useful construct than coping for predicting PD and other psychological outcomes in females with endometriosis.

“When I’m in Pain, Everything Is Overwhelming”: Implications of Pain in Adults With Autism on Their Daily Living and Participation

Pain sensation in autism spectrum disorder (ASD) has been a growing research field in the last two decades. Existing pain research has focused on pain sensitivity, suggesting either hyposensitivity or hypersensitivity to pain in individuals with ASD. However, research about other aspects of pain experience is scarce. Moreover, most pain-related research in ASD focused on quantitative measures, such as neuroimaging or parental reports. Instead, this paper aimed to illuminate the various aspects of pain experience as perceived by adults with ASD. Its descriptive qualitative research design incorporated semi-structured interviews and deductive thematic analysis. This phenomenological approach captured the subjective pain experience through the lens of people with ASD. Four primary themes emerged from the data: (a) physical pain experience, including the sequence of pain sensitivity, pain awareness, pain-related emotional aspects, and pain communication; (b) direct and indirect coping strategies; (c) function and participation outcomes; and (d) suggestions for Healthcare Providers. The findings echo the crucial role of pain awareness and communication in the pain experience of people with ASD. These two factors have been reported as profoundly influencing coping strategies, function, and participation. The results emphasize the need to expand the exploration of pain in this population, calling for greater understanding, and listening to this population’s unique pain profiles and experiences to promote better-suited evaluation, diagnosis, and intervention in pain conditions.

Preferred self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. A modified Delphi study

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.

Distinct Psychological Characteristics Predict Resilience and Recovery Throughout Widowhood

The dual-process model proposes that early and later bereavement involves different types of stressors and adaptation processes (Stroebe & Schut, 1999, 2010). It is thus possible that different factors facilitate adaptation during the early months versus subsequent years following widowhood. Elevated depressive symptoms, though prevalent after widowhood, may indicate problematic adaptation, as they are associated with poor long-term physical and mental health outcomes. We predicted that neutral death acceptance would be associated with less increase in depression during early widowhood (when confronted with loss-oriented stressors), whereas perceived control would predict depressive symptom decline during later widowhood (when adapting to controllable restoration-oriented stressors). Older adults (N = 265) reported on neutral death acceptance, perceived control, and depression before widowhood and on depression 0.5, 1.5, and 4.0 years after the death of their spouse. Bilinear spline growth modeling revealed that, on average, depressive symptoms increased from before to 0.5 years after spouse death and fell from 0.5 to 4.0 years after spouse death. Neutral death acceptance predicted a smaller increase in depression from before to 0.5 years after spouse death, as well as a smaller subsequent decrease in depression from 0.5 to 4.0 years after spouse death. Perceived control predicted a larger decrease in depression from 0.5 to 4.0 years after spouse death. Neutral death acceptance and perceived control had unique associations with resilience and recovery throughout early and later widowhood. These variables may be fruitful targets in interventions for depression throughout the full course of widowhood.

Health-related quality of life in patients with chronic orofacial pain compared with other chronic pain patients

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.

The Role of Experiential Avoidance in Terms of Fatigue and Pain During COVID-19 Among Latinx Adults

Background

Latinx persons are overrepresented in terms of 2019 Coronavirus (COVID-19) infection rates and constitute a subpopulation at increased risk for COVID-19 related physical ailments. Fatigue and pain are among the most prevalent somatic symptoms among the Latinx population; however, there is little understanding of individual difference factors that are related to fatigue and pain during COVID-19 among this health disparities population. Experiential avoidance (EA) reflects the persistent tendency to avoid aversive internal sensations.

Methods

The current study sought to extend past work by exploring EA in relation to fatigue severity, pain intensity, and pain disability among 182 Latinx adult persons during the COVID-19 pandemic.

Results

Results indicated that EA accounted for a statistically significant amount of variance across the criterion variables.

Conclusions

Overall, the current work provides initial empirical evidence that EA is related to greater fatigue severity and pain severity/disability among Latinx persons during COVID-19.

Pain acceptance and illness intrusiveness in low-back pain: A longitudinal study

BACKGROUND

In chronic pain syndromes, acceptance of pain may be a better approach than pain control. So far, little data have been available on how pain and its acceptance affect illness intrusiveness among patients with low-back pain (LBP).

OBJECTIVE

The present longitudinal study evaluates the impact of pain acceptance on illness intrusiveness in patients with LBP.

METHODS

Study participants were asked to complete the following questionnaires during their visit (T1) at one of four diverse rheumatologic outpatient clinics, and then 2-3 months later (T2) via phone or online: Chronic Pain Acceptance Questionnaire (CPAQ), Illness Intrusiveness Rating Scale (IIRS), Roland-Morris Disability Questionnaire (RMDQ), Patient Health Questionnaire Depression subscale (PHQ9), and socioeconomic data.

RESULTS

One hundred and twenty-seven individuals completed the questionnaires at baseline (31 having acute, 15 subacute and 81 chronic low back pain) and 97 at follow-up. Illness intrusiveness was negatively correlated with chronic pain acceptance both at T1 (r = -0.39) and T2 (r = -0.44). Illness intrusiveness scores have not changed significantly from T1 (M = 28.59 SD = 13.08) to T2 (M = 28.24, SD = 15.76). In a multiple regression model-including pain intensity, functional status, pain acceptance, depression severity, age, sex and educational level-the independent predictors of follow-up illness intrusiveness scores were lower pain acceptance and higher depression scores.

CONCLUSIONS

In our study, patients with acute, subacute and chronic low back pain reported similar levels of illness intrusiveness. In addition, illness intrusiveness scores have not changed significantly during the 2-month follow-up period and pain acceptance proved to be a significant independent predictor of illness intrusiveness among patients with chronic low-back pain.

The effectiveness of exercise therapy and education plus cognitive behavioral therapy, alone or in combination with total knee arthroplasty in patients with knee osteoarthritis - study protocol for the MultiKnee trial

Background

One in five patients report chronic pain following total knee arthroplasty (TKA) and are considered non-improvers. Psychological interventions such as cognitive behavioral therapy (CBT), combined with exercise therapy and education may contribute to reduced pain an improved function both for patients with OA or after TKA surgery, but the evidence for the effectiveness of such interventions is scarce. This randomized controlled trial with three arms will compare the clinical effectiveness of patient education and exercise therapy combined with internet-delivered CBT (iCBT), evaluated either as a non-surgical treatment choice or in combination with TKA, in comparison to usual treatment with TKA in patients with knee OA who are considered candidates for TKA surgery.

Methods

The study, conducted in three orthopaedic centers in Norway will include 282 patients between ages 18 and 80, eligible for TKA. Patients will be randomized to receive the exercise therapy + iCBT, either alone or in combination with TKA, or to a control group who will undergo conventional TKA and usual care physiotherapy following surgery. The exercise therapy will include 24 one hour sessions over 12 weeks led by a physiotherapist. The iCBT program will be delivered in ten modules. The physiotherapists will receive theoretical and practical training to advise and mentor the patients during the iCBT program. The primary outcome will be change from baseline to 12 months on the pain sub-scale from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the remaining 4 sub-scales from the KOOS (symptoms, function in daily living, function in sports and recreation, and knee-related quality of life), EQ-5D-5L, the Pain Catastrophizing Scale, the 30-s sit-to-stand test, 40-m walking test and ActiGraph activity measures. A cost-utility analysis will be performed using QALYs derived from the EQ-5D-5L and registry data.

Discussion

This is the first randomized controlled trial to investigate the effectiveness of exercise therapy and iCBT with or without TKA, to optimize outcomes for TKA patients. Findings from this trial will contribute to evidence-based personalized treatment recommendations for a large proportion of OA patients who currently lack an effective treatment option.

Trial registration

Clinicaltrials.gov: NCT03771430. Registered: Dec 11, 2018.

A Randomized controlled trial of the Sources of Meaning Card Method: A new meaning-oriented approach predicts depression, anxiety, pain acceptance, and crisis of meaning in chronic pain patients

OBJECTIVE

Although considered the first-line psychological treatment of chronic pain, cognitive behavioural therapy has recently been criticized as being too limited, insufficient, and sometimes ineffective in the treatment of chronic pain patients. Moreover, important existential perspectives are sparsely or not at all integrated into CBT. We therefore propose to complement chronic pain treatment with a meaning-based intervention, the Sources of Meaning Card Method (SoMeCaM). This study tested its efficacy.

DESIGN

A randomized controlled trial was conducted with 42 chronic pain patients, comparing an intervention group (standard care and participation in the SoMeCaM, a meaning-oriented approach) with a control group (standard care). We evaluated both groups at baseline, 1 (t1) and 2 months (t2) after the intervention. The primary outcome assessed was pain acceptance, while depression, anxiety, pain intensity, pain medication, satisfaction with life, meaningfulness, and crisis of meaning were examined as secondary outcomes.

RESULTS

Comparisons within and between groups showed significant treatment effects at t1. Higher increases in pain acceptance and decreases in anxiety, depression and crisis of meaning were observed in the intervention group. Improvements in pain acceptance and anxiety persisted until t2, when pain intensity was also lower. Effect sizes at t2 were medium to large.

CONCLUSION

Our preliminary work demonstrates the importance of the existential perspective in chronic pain therapy.

Pathways to Acceptance in Participants of Advanced Cancer Online Support Groups

Background and Objectives: Individuals with cancer, especially advanced cancer, are faced with numerous difficulties associated with the disease, including an earlier death than expected. Those who are able to confront and accept the hardships associated with the disease in a way that aligns with their beliefs benefit from more positive psychological outcomes compared to those who are aware of their diagnosis but are unable to accept it. To date, there is limited research exploring factors contributing to illness and death acceptance in the context of advanced cancer in group therapy settings. Materials and Methods: The current study used a Directed Content Analysis approach on transcripts of online advanced cancer support groups to investigate if and how Yalom’s existential factors played a role in the emergence of acceptance. Results: The online support group platform, combined with the help of facilitators, offered supportive environments for individuals seeking help with cancer-related distress by helping patients move towards acceptance. Some participants had already begun the process of accepting their diagnosis before joining the group, others developed acceptance during the group process, while a few continued to be distressed. Our analysis revealed the emergence of four themes related to illness acceptance: (1) Facilitator-Initiated Discussion, including sub-themes of Mindfulness, Relaxation and Imagery, Changing Ways of Thinking, and Spirituality; (2) Personal attitudes, including sub-themes of Optimism and Letting Go of Control; (3) Supportive Environment, including the sub-themes of Providing Support to Others and Receiving Support from Others; and (4) Existential Experience, which included sub-themes of Living with the Diagnosis for an Extended Amount of Time, Legacy and Death Preparations, and Appreciating life. Conclusions: With a paradigm shift to online delivery of psychological services, recognizing factors that contribute to acceptance when dealing with advanced cancer may help inform clinical practices. Future studies should explore patient acceptance longitudinally to inform whether it emerges progressively, which has been suggested by Kübler-Ross.

Injustice Through Cultural Lens: A Pilot Qualitative Exploration of Pain-Related Injustice Appraisals Among Arab-Americans with Chronic Low Back Pain

The current qualitative study sought to obtain an in-depth understanding of how Arab-Americans conceptualize perceived injustice concerning their chronic low back pain (CLBP) by reflecting on the Injustice Experience Questionnaire (IEQ). Twelve Arab-American adults with CLBP were recruited from a metropolitan area in Alabama using a purposive sampling technique. Participants took part in individual, face-to-face, semi-structured interviews reflecting on each statement from the IEQ. Descriptive data analysis was generated for demographic and pain variables. Directed content analysis was conducted to identify themes and sub-themes. 'Blame and unfairness' and 'severity and irreparability of loss,' the 2 established theoretical factors comprising pain-related injustice appraisal were used as predominant themes. Acceptance emerged as an inductive theme with the following sub-themes: positive appraisal and resilience, attempts to reduce pain, religious values and fate, and belief that everything happening for a reason. The influence of religion was noted across all themes. The current pilot findings suggest that Arabic culture, heavily infused with Islamic beliefs, influences how Arab-Americans conceptualize pain-related injustice appraisals. Additional exploration of the cultural appropriateness of the IEQ among individuals of Arab background is needed to further elaborate on the subject of faith and religious belief suggested by the current study. Perspective: Although the study findings largely reflected established injustice literature constructs, several emergent themes regarding pain-related injustice appraisal were influenced by the participants' culture and religious beliefs. These findings may indicate that specific psychotherapeutic approaches that have been proven effective among some groups may not function similarly in other populations.

Development of an internet-delivered cognitive behavioral therapy program for use in combination with exercise therapy and education by patients at increased risk of chronic pain following total knee arthroplasty

Background

Approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Due to the growing number of TKA procedures, this will affect an increasing number of people worldwide. Catastrophic thinking, dysfunctional illness perception, poor mental health, anxiety and depression characterize these non-improvers, and indicate that these patients may need individualized treatment using a treatment approach based on the bio-psycho-social health model. The present study developed an internet-delivered cognitive behavioral therapy (iCBT) program to be combined with exercise therapy and education for patients with knee osteoarthritis (OA) at increased risk of chronic pain after TKA.

Methods

The development process followed the first two phases of the UK Medical Research Council framework for complex interventions. In the development phase, the first prototype of the iCBT program was developed based on literature review, established iCBT programs and multidisciplinary workshops. The feasibility phase consisted of testing the program, interviewing users, condensing the program, and tailoring it to the patient group. A physiotherapist manual was developed and adapted to physiotherapists who will serve as mentors.

Results

The development process resulted in an iCBT program consisting of 10 modules with educational texts, videos and exercises related to relevant topics such as goalsetting, stress and pain, lifestyle, automatic thoughts, mindfulness, selective attention, worry and rumination. A physiotherapist manual was developed to guide the physiotherapists in supporting the patients through the program and to optimize adherence to the program.

Conclusions

The iCBT program is tailored to patients at risk of chronic pain following TKA, and may be useful as a supplement to surgery and/or exercise therapy. A multicentre RCT will evaluate the iCBT program in combination with an exercise therapy and education program. This novel intervention may be a valuable contribution to the treatment of OA patients at risk of chronic pain after TKA.

Trial registration

The RCT is pre-registered at ClinicalTrials.gov: NCT03771430 11/12/2018. 

Evaluation of the health literacy level of female fibromyalgia patients and relationship between health literacy level and disease activity

Objectives

This study aims to evaluate the health literacy in women with fibromyalgia (FM) and relationship between health literacy and disease activity.

Patients and methods

This cross-sectional study included a total of 32 female patients (mean age: 46.2±8.8 years; range, 28 to 62 years) with FM according to the 2016 American College of Rheumatology classification criteria and 27 healthy female controls (mean age: 41.7±12.6 years; range, 24 to 65 years) between May 2020 and July 2020. Demographic and clinical characteristics were recorded. Health literacy levels of the participants were assessed with the Turkish version of European Health Literacy Scale (EHLS-TR), disease activity by Fibromyalgia Impact Questionnaire (FIQ), and pain level with the Numerical Rating Scale (NRS).

Results

Age, education, marital status, and residential area were similar between the groups. There was a significant difference in the job and income level between the groups (p=0.004 and p<0.001, respectively). The EHLS-TR scores were significantly lower, in FM group compared to the control group (p=0.006, p<0.001, and p<0.001, respectively). There was a negative correlation between the EHLS-TR scores and age in the FM group (r=-0.499, p<0.001). A positive significant correlation was found between education status, income level, and EHLS-TR scores in the FM group (r=0.416, p<0.05 and r=0.316, p<0.05, respectively).

Conclusion

Our study results suggest that healthy literacy level is lower in patients with FM compared to healthy controls. In addition, healthy literacy is associated with age, education status, and income level in this patient population.

Pain acceptance and its impact on function and symptoms in fibromyalgia

Objectives Fibromyalgia is a chronic widespread pain (CWP) syndrome of unknown etiology with substantial burden of illness and functional impairment. Pain acceptance has emerged as an interesting target of therapy in chronic pain populations, but few studies have yet been done on the effect of pain acceptance on patients with fibromyalgia. The aim of the present study was to examine the relationship between pain acceptance and its impact on function and symptoms in fibromyalgia with both a cross-sectional and longitudinal design. Methods Three hundred and sixty five participants aged 22-70 with fibromyalgia were recruited from the Norwegian Fibromyalgia Association (NFA). They filled out a questionnaire containing the Fibromyalgia Impact Questionnaire (FIQ), measurement of function and symptoms, and Chronic Pain Acceptance Questionnaire (CPAQ), measurement of pain acceptance, in addition to sociodemographic and clinical variables such as degree of fibromyalgia, depression and pain duration (T1 measures). One year after, 87 of the participants filled out the FIQ and clinical measures once again (T2 measures). Unadjusted and adjusted linear regression analyses were performed both for cross-sectional measures at T1 and for longitudinal measures from T1 to T2, with FIQ score as the outcome variable and CPAQ score at T1 as one of the main independent variables. Results Higher CPAQ score was significantly associated with a lower FIQ score at T1, also when adjusting for age, education, work, depression and Fibromyalgianess Score (p<0.01). Lower FIQ score indicate less impact of fibromyalgia on functioning. In addition, two adjusted linear regression models found higher pain acceptance (CPAQ score) at T1 to be associated with lower negative impact of fibromyalgia on function and symptoms (FIQ score) at T2 (p<0.01). Conclusions Higher pain acceptance is associated with better functional level and less symptoms in fibromyalgia, both cross-sectionally and when measurements are separated in time. Further research should include experimental studies with acceptance-based interventions for this patient group.

Only two subscales of the Coping Strategies Questionnaire are culturally relevant for people with chronic low back pain in Nigerian Igbo populations: a cross-cultural adaptation and validation study

Background

Pain coping strategies are important in the chronicity of low back pain and the associated disability. However, their exact influence is unknown in many African contexts such as rural Nigeria due to lack of outcome instruments with which to measure them. This study aimed to cross-culturally adapt and psychometrically test the Coping Strategies Questionnaire (CSQ) in Igbo populations in Nigeria.

Methods

The CSQ was forward and back translated by clinical and non-clinical translators; evaluated by an expert review committee. The translated measure was piloted amongst twelve rural Nigerian dwellers with chronic low back pain (CLBP) using the think-aloud cognitive interviewing style. Internal consistency (Cronbach’s alpha), test–retest reliability (intra-class correlation coefficient—ICC and Bland–Altman plot), and minimal detectable change were examined amongst 50 people with CLBP in rural and urban Nigerian populations. Construct validity was determined by assessing the correlations between the adapted CSQ and measures of disability, pain intensity, fear avoidance beliefs, and illness perceptions using Spearman’s correlation analyses with 200 adults with CLBP in rural Nigeria. Exploratory factor analyses using Kaiser criterion (eigenvalue) and parallel analysis as methods for determining dimensionality were conducted with the same sample.

Results

Fourteen out of 42 items were routinely adopted in this population including all items of catastrophising subscale, and all but one item of praying and hoping subscale. Catastrophising and praying and hoping subscales had the highest Cronbach’s alpha. All subscales had high ICCs with Bland–Altman plots that showed good agreement. All coping strategies were positively correlated with self-reported disability and pain intensity with catastrophising subscale having the highest values. Seven-factor and three-factor structures were produced with the Kaiser criterion and parallel analysis, with different items from the original CSQ, except for catastrophising.

Conclusions

Catastrophising and praying and hoping may be the relevant coping strategies in this population. More culturally relevant measures of pain coping strategies that include adaptive coping strategies may need to be developed for African contexts such as rural Nigeria.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00367-1.

Contribution of abnormal BMI to adverse health-related quality of life outcomes after a 52-week therapy in patients with SLE

OBJECTIVES

To investigate whether abnormal BMI is associated with adverse health-related quality of life (HRQoL) outcome, including severe fatigue, after 52 weeks of standard therapy plus belimumab or placebo in patients with SLE.

METHODS

We analysed data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (n = 1684). Adverse HRQoL was defined as SF-36 scores ≤ the fifth percentile in age- and sex-matched US population-based subjects, and FACIT-F scores <30. We compared BMI groups using the Pearson's χ2 test, and assessed independence with multivariable logistic regression analysis.

RESULTS

Overweight (BMI ≥25 kg/m2) and obese (BMI ≥30 kg/m2) patients showed increased likelihood to exhibit adverse SF-36 physical component summary (OR: 1.8; 95% CI: 1.4, 2.3; P <0.001 and OR: 2.4; 95% CI: 1.8, 3.2; P <0.001, respectively) and FACIT-F (OR: 1.3; 95% CI: 1.1, 1.6; P = 0.010 and OR: 1.5; 95% CI: 1.2, 2.0; P = 0.002, respectively) scores at week 52. Underweight was associated with adverse SF-36 mental component summary scores, also after adjustment for sex, ancestry, age, disease duration, disease activity, organ damage and prednisone dose during the study period (OR: 2.1; 95% CI: 1.2, 3.6; P = 0.007). Addition of belimumab to standard therapy independently protected against adverse SF-36 general health (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.025) and FACIT-F < 30 (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.018).

CONCLUSION

Overweight and obesity contributed to adverse physical and mental HRQoL outcomes after therapeutic intervention in SLE patients, and underweight contributed to adverse mental HRQoL outcome. A protective effect of belimumab against adverse general health and severe fatigue was implicated.

What Does the Psychological Flexibility Model Contribute to the Relationship Between Depression and Disability in Chronic Pain? The Role of Cognitive Fusion and Pain Acceptance

This study examines the mediator role of cognitive fusion between depressive symptoms, activity avoidance and excessive persistence at different levels of pain acceptance (moderator) among fibromyalgia patients (FM). Using a sample of 231 women, multiple and moderate mediation analyses were conducted with PROCESS. Results showed that depression was positively associated with activity avoidance and excessive persistence. Furthermore, cognitive fusion and pain acceptance were found to mediate the effect of depression in both patterns. Additionally, pain acceptance was found to play a contextual role in cognitive fusion, as a moderator, between depressive symptoms and maladaptive patterns. Specifically, FM patients with high acceptance levels and low levels of depression presented the strongest associations between depression and cognitive fusion. Techniques aimed at reducing cognitive fusion, could be especially beneficial to FM women with high pain acceptance.

Coping Patterns Among Primary Informal Dementia Caregivers in Singapore and Its Impact on Caregivers-Implications of a Latent Class Analysis

BACKGROUND AND OBJECTIVES

Existing studies typically explore the factor structure of coping strategies among dementia caregivers. However, this approach overlooks the fact that caregivers often use different coping strategies simultaneously. This study aims to explore the coping patterns of primary informal dementia caregivers in Singapore, examine their significant correlates, and investigate whether different patterns would affect the depressive symptoms of caregivers.

RESEARCH DESIGN AND METHODS

Two hundred eighty-one primary informal caregivers of persons with dementia (PWD) were assessed. Coping strategies were measured by the Brief Coping Orientation to Problem Experienced inventory. A latent class analysis was performed to explore caregivers' coping patterns, followed by logistic regressions to identify the significant correlates and the relationships between coping patterns and caregiver depression.

RESULTS

The latent class analysis suggested a three-class solution that was featured by the frequency and variety of coping strategies used by caregivers-high coping (36.3%), medium coping (37.7%), and low coping (26.0%). Factors influencing the coping patterns of our sample were mainly related to caregivers' individual resources such as personal characteristics and caregiving stressors like PWD's problematic behaviors and caregiving burden. Compared to caregivers in the low coping group, those in the medium coping group had significantly higher risks of potential depression.

DISCUSSION AND IMPLICATIONS

The current study confirmed that there are distinct coping patterns among primary informal dementia caregivers, and caregivers with the low coping pattern had fewer depressive symptoms. Future research is needed to explore if coping patterns from our sample are generalizable to dementia caregivers elsewhere.

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

"I'm empowered to look after myself" - Mindfulness as a way to manage chronic pain: An interpretative phenomenological analysis of participant experiences in Scotland

BACKGROUND AND PRIMARY AIM

Chronic pain is a common problem that can impact on psychological and social wellbeing and activity levels. Despite pharmacological treatments, there is often a lack of improvement in physical and emotional functioning and health-related quality of life. Mindfulness meditation has become an increasingly popular self-management technique. The aim of the study was to explore the experiences of patients with chronic pain who took part in a mindfulness programme.

METHODS

A mixed-methods feasibility study was carried out. Participants were aged 18 years or over with non-malignant chronic pain recruited from general medical practices in Fort William, Scotland. In 2013 participants undertook an eight-week mindfulness programme based on Mindfulness-Based Stress Reduction (MBSR) and were interviewed immediately post-programme and at eight-months' post-programme. Analysis of qualitative data involved Interpretative Phenomenological Analysis (IPA).

FINDINGS

Thirty-four patients consented to take part in the study; twenty-four took part in the programme (14 attended four or more sessions, 10 attended one to three). Twenty-three were interviewed. Participant experiences of the programme were themed under: factors affecting experience (influence of earlier life events; the process of taking part in, and of relating to, the programme); and effects of the programme (impact on emotions, mental health, adverse events and a process of change). The process of change, resulting after better understanding the relationship between mindfulness and pain, involved learning to 'listen to the body', gaining a sense of community, learning to accept pain, and approaching life with more self-care, awareness, appreciation and empowerment.

CONCLUSION

Participants reported a variety of experiences. For some, these included undergoing a process of change which may have supported them in living with their painful condition. This contributes to our understanding of how mindfulness could benefit people with chronic pain.

Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis

Acceptance and Commitment Therapy (ACT) has been widely tested for chronic pain, with demonstrated efficacy. Nevertheless, although there is meta-analytical evidence on the efficacy of face-to-face ACT, no reviews have been performed on online ACT in this population. The aim of this meta-analysis is to determine the efficacy of online ACT for adults with chronic pain, when compared with controls. PubMed, PsycINFO, CENTRAL, and Web of Knowledge were searched for randomized controlled trials (RCTs) of online-delivered ACT for chronic pain. Effects were analyzed at post-treatment and follow-up, by calculating standardized mean differences. Online-delivered ACT was generally favored over controls (5 RCTs, N = 746). At post-treatment, medium effects for pain interference and pain acceptance, and small effects for depression, mindfulness, and psychological flexibility were found. A medium effect for pain interference and acceptance, and small effects for pain intensity, depression, anxiety, mindfulness, and psychological flexibility were found at follow-up. ACT-related effects for pain interference, pain intensity, mindfulness, and anxiety increased from post-treatment to follow-up. Nevertheless, the current findings also highlight the need for more methodologically robust RCTs. Future trials should compare online ACT with active treatments, and use measurement methods with low bias. PERSPECTIVE: This is the first meta-analytical review on the efficacy of online ACT for people with chronic pain. It comprises 5 RCTs that compared online ACT with active and/or inactive controls. Online ACT was more efficacious than controls regarding pain interference, pain intensity, depression, anxiety, mindfulness, and psychological flexibility.

A Systematic Review of Self-Compassion in Chronic Pain: From Correlation to Efficacy

Chronic pain (CP) is a common condition affecting millions of people worldwide. Compassion-related interventions are proving to be advantageous in CP, and self-compassion (SC) is hypothesized to be related with pain regulation physiological processes, as well as with psychological benefits in CP. We aimed to review scientific literature on: 1) Compassion-based psychological interventions and their changes in pain outcomes; and 2) associations between SC and pain-related outcomes. We performed a systematic research in four electronic databases: MEDLINE, EMBASE, PsycINFO and the Cochrane Library from inception until April 2020. In Question 1, we included studies involving adult patients with CP who participated in compassion-based psychological interventions. In Question 2, we included studies that examined the associations between SC and pain outcomes in adults with CP. We identified 16 studies. For Question 1, we included seven studies focused on different compassion-based interventions that assessed at least one pain outcome, in a total of 253 participants with CP associated with multiple conditions. For Question 2, we included nine studies, in a total of 1,430 participants, with eight different pain outcomes: Intensity, acceptance, catastrophizing, self-efficacy, disability, distress, pain related coping and anxiety. Considering the high heterogeneity between studies and the poor-quality assessment, we could not draw definitive conclusions on the efficacy of compassion-based interventions nor on the association between SC and pain outcomes. Studies are further discussed in detail. This review can be a starting point for large-scale and high-quality trials in this area as it provides an organized overview of the current literature on this topic.

Efficacy of an ACT and Compassion-Based eHealth Program for Self-Management of Chronic Pain (iACTwithPain): Study Protocol for a Randomized Controlled Trial

BACKGROUND

Chronic pain (CP) has serious medical and social consequences and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving their quality of life is timely. Although acceptance and commitment therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a medical TAU group.

METHODS

The eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise eight weekly self-management sessions and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyze whether the iACTwithPain intervention will present superiority in improving CP's impact and related health markers over the two other conditions, this study will follow an RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-month follow-ups. The interventions' acceptability will also be assessed.

DISCUSSION

The iACTwithPain intervention is expected to improve CP patients' psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP.

CLINICAL TRIAL REGISTRATION

This trial has been registered at ClinicalTrials.Gov (NCT04200183; 16 December 2019; https://clinicaltrials.gov/ct2/show/NCT04200183). The current manuscript comprises the first version of this clinical trial's protocol.

Coping With COVID-19: Mindfulness-Based Approaches for Mitigating Mental Health Crisis

The novel coronavirus disease COVID-19 that first emerged in Wuhan, China, in Nov-Dec 2019 has already impacted a significant proportion of the world population. Governments of many countries imposed quarantines and social distancing measures in 2020, many of which remain in place, to mitigate the spread of the SARS-Cov-2 virus causing the COVID-19 disease. The direct impact of COVID-19 on people infected with the virus, their families and the health care workers, as well as the impact of the mitigation measures such as quarantine, social distancing, and self-isolation on the rest of the population have contributed to a global mental health pandemic, including anxiety, depression, panic attacks, posttraumatic stress symptoms, psychosis, addiction, obsessive-compulsive disorder, and suicidality. These effects are present acutely (for example, due to fear of contamination or losing loved ones, effects of quarantine/isolation, withdrawal of community and social services, etc.) and may continue long after the pandemic is over (for example, due to bereavement, unemployment, financial losses, etc). The COVID-19 pandemic has triggered mental health problems in people without previous history of mental illness, as well as worsened the symptoms in those with pre-existing psychiatric diagnosis. Therefore, the global effort is called for to deal with this mental health pandemic secondary to COVID-19 itself to address the emergence of new as well as the exacerbation of the existing mental health issues. Conversely, this global context provides an extraordinary opportunity for studying individual differences in response to and resilience in the face of physical and psychological threat, challenge to "normal" way of life, and long-term uncertainty. In this viewpoint article we outline the particular suitability of mindfulness, its skills and mechanisms, as an approach to the prevention and management of mental health issues, as well as to the promotion of well-being and building the foundations of adaptability and flexibility in dealing with the long-term uncertainty and profound changes to the social, economic, and possibly political systems as this pandemic continues to unfold.

Life with chronic pain during COVID-19 lockdown: the case of patients with small fibre neuropathy and chronic migraine

Objective

We aimed at investigating the impact of COVID-19-related distress on patients with chronic pain, highlighting the effects of changes in individual habits and public health care reconfiguration on physical and psychological health.

Methods

During the pandemic, 80 participants (25 patients with small fibre neuropathy (SFN), 42 patients with chronic migraine (CM) and 13 patients’ healthy family members (HFM)) were asked to evaluate their COVID-19 complains, changes in habits and clinical management, behaviour, mood, loneliness, quality of life (QoL), physical and mental health and coping strategies. Data were analysed by Spearman rho correlations and Mann-Whitney U tests.

Results

Patients had lower QoL, lower physical health and higher catastrophizing attitude towards pain than HFM. During the pandemic, SFN patients referred greater decline in clinical symptoms, worries about contagion and discomfort for disease management changes than CM patients. In the SFN group, the higher levels of disability were associated with suffering from changes in neurologist-patient relationship. CM patients complained of agitation/anxiety that was related to feelings of loneliness, depressive mood and catastrophism.

Discussion

Despite similar complains of change in habits and worries about COVID-19 pandemic, SFN and CM patients had distinct reactions. In SFN patients, pandemic distress impacted on physical health with worsening of clinical conditions, especially suffering from changes in their care. In CM patients, pandemic distress affected behaviour, mainly with psychological frailty. This suggests the need to customize public health care for patients with distinct chronic pain conditions.