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Burns JW, Gerhart J, Smith DA, Porter L, Rye B, Keefe F. Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain. Pain 2024; 165:1559-1568. [PMID: 38334493 DOI: 10.1097/j.pain.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/04/2023] [Indexed: 02/10/2024]
Abstract
ABSTRACT People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.
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Affiliation(s)
- John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States
| | - David A Smith
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Laura Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Bonny Rye
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Leroux A, Crainiceanu C, Zeger S, Taub M, Ansari B, Wager TD, Bayman E, Coffey C, Langefeld C, McCarthy R, Tsodikov A, Brummet C, Clauw DJ, Edwards RR, Lindquist MA. Statistical modeling of acute and chronic pain patient-reported outcomes obtained from ecological momentary assessment. Pain 2024:00006396-990000000-00594. [PMID: 38718196 DOI: 10.1097/j.pain.0000000000003214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/11/2024] [Indexed: 05/18/2024]
Abstract
ABSTRACT Ecological momentary assessment (EMA) allows for the collection of participant-reported outcomes (PROs), including pain, in the normal environment at high resolution and with reduced recall bias. Ecological momentary assessment is an important component in studies of pain, providing detailed information about the frequency, intensity, and degree of interference of individuals' pain. However, there is no universally agreed on standard for summarizing pain measures from repeated PRO assessment using EMA into a single, clinically meaningful measure of pain. Here, we quantify the accuracy of summaries (eg, mean and median) of pain outcomes obtained from EMA and the effect of thresholding these summaries to obtain binary clinical end points of chronic pain status (yes/no). Data applications and simulations indicate that binarizing empirical estimators (eg, sample mean, random intercept linear mixed model) can perform well. However, linear mixed-effect modeling estimators that account for the nonlinear relationship between average and variability of pain scores perform better for quantifying the true average pain and reduce estimation error by up to 50%, with larger improvements for individuals with more variable pain scores. We also show that binarizing pain scores (eg, <3 and ≥3) can lead to a substantial loss of statistical power (40%-50%). Thus, when examining pain outcomes using EMA, the use of linear mixed models using the entire scale (0-10) is superior to splitting the outcomes into 2 groups (<3 and ≥3) providing greater statistical power and sensitivity.
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Affiliation(s)
- Andrew Leroux
- Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Margaret Taub
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Briha Ansari
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tor D Wager
- Department of Psychological and Brain Science, Dartmouth College, Hanover, NH, United States
| | - Emine Bayman
- Departments of Biostatistics and
- Anesthesia, University of Iowa, Iowa City, IA, United States
| | | | - Carl Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, United States
- The Comprehensive Cancer Center of Wake Forest University, Winston Salem, NC, United States
| | - Robert McCarthy
- Department of Anesthesiology, Rush University, Chicago, IL, United States
| | | | - Chad Brummet
- Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Daniel J Clauw
- Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Robert R Edwards
- Harvard Medical School, Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, MA, United States
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Yang Y, Mischkowski D. Integrating intra- and interpersonal perspectives on chronic low back pain: the role of emotion regulation and attachment insecurity. Front Psychol 2024; 15:1331227. [PMID: 38680279 PMCID: PMC11050035 DOI: 10.3389/fpsyg.2024.1331227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/15/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Chronic low back pain (CLBP) is burdensome and interferes with psychological and physical functioning of those affected. Past research has examined interpersonal (e.g., attachment insecurity) or intrapersonal factors (e.g., emotion regulation [ER]) involved in chronic pain. However, to enhance our understanding of CLBP's biopsychosocial underpinnings, more empirical integration of both intra- and interpersonal factors involved in CLBP is needed. Thus, our study examined the independent and joint associations of insecure attachment dimensions and ER strategies with CLBP severity and interference. Methods We recruited 242 US adults with CLBP through Prolific Academic, an online participant pool. Participants from Prolific Academic were eligible for the study if they were at least 18 years of age, resided in the US, reported CLBP at least half the days over the past 6 months (>3 months), and used prescribed pain medication for their CLBP. Data collection was between November 2021 and February 2022. Eligible participants filled out a Qualtrics survey which consisted of measures assessing insecure attachment dimensions, ER strategies, as well as demographical information. Outcome variables in the present study were CLBP severity and interference. We ran multiple linear regression models to examine the associations between ER strategies and insecure attachment dimensions as predictors, and CLBP severity or interference as predicted variables, after controlling for sex as a covariate; we also conducted moderation analyses to investigate the interactions between ER strategies and insecure attachment dimensions when testing associations with CLBP severity or interference. Results Our results indicated that, after controlling for ER strategies, anxious attachment was positively associated with CLBP interference but not pain severity (CI: 0.101 to 0.569; CI: -0.149 to 0.186); avoidant attachment was not associated with CLBP interference or severity (CI: -0.047 to 0.511; CI: -0.143 to 0.256). After adjusting for anxious and avoidant attachment, emotional expression and expressive suppression were positively associated with CLBP severity (CI: 0.037 to 0.328; CI: 0.028 to 0.421) but not interference (CI: -0.003 to 0.403; CI: -0.406 to 0.143). Furthermore, emotional expression was associated with CLBP severity and interference at low and medium levels of avoidant attachment (CI: 0.165 to 0.682; CI: 0.098 to 0.455); expressive suppression and cognitive reappraisal did not interact with attachment dimensions when examining CLBP severity or interference (CIs: LLs ≤ -0.291 to ULs ≥ 0.030). Conclusion Our study shows that anxious attachment may be an interpersonal risk factor related to CLBP, above and beyond intrapersonal ERs, as anxious attachment was associated with higher levels of pain interference. Furthermore, emotional expression was associated with increased CLBP severity and interference, particularly among individuals at low and medium levels of avoidant attachment. Existing studies on chronic pain have mostly focused on examining intrapersonal or interpersonal correlates in isolation. The present study extends our understanding of CLBP by considering the role of interpersonal factors (i.e., insecure attachment dimensions), in combination with intrapersonal ER strategies. Given the correlational nature of the present study, longitudinal studies are needed to establish causality between psychosocial correlates and CLBP symptoms. Ultimately, we hope our integrated approach will facilitate the development of treatments and interventions tailored to address patients' attachment-related needs, enhancing the management and maintenance of CLBP among patients.
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Affiliation(s)
- Yixin Yang
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Dominik Mischkowski
- Department of Psychology, University of Illinois at Urbana- Champaign, Champaign, IL, United States
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Körner AJ, Sabatowski R, Burdic L, Beyer L, Gärtner A, Schönbach B, Kaiser U. [Emotional competence of patients with chronic pain : A self- and third-party assessment]. Schmerz 2024; 38:125-131. [PMID: 37278837 PMCID: PMC10959775 DOI: 10.1007/s00482-023-00720-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 06/07/2023]
Abstract
RESEARCH QUESTION The aim of the study is to assess the status quo of emotional competence in people with chronic pain. How do patients experience themselves regarding to their ability to perceive, express, and regulate emotions? And does this assessment coincide with the assessment of emotional competence (EC) by mental health professionals? METHODS The study took place in the context of interdisciplinary multimodal pain therapy at an outpatient clinic in N = 184 adult German-speaking individuals with non-cancer-related chronic pain. EC was assessed at the end of therapy using the self- and third-party assessment scales of the Emotional Competence Questionnaire. The external assessment was performed by the mental health team. Standard scores were created using the norm sample provided by questionnaires. These were analyzed descriptively and inferentially. RESULTS Self-perceived EC was average (Mself_total = 99.31; SD = 7.78). The mental health professionals predominantly rated the emotional competence of the patients significantly lower (Mexternal_total = 94,70; SD = 7,81; F(1.179) = 35,73; p < 0.001; η2 = 0.17). Emotional expressivity, as a component of EC, was externally rated as below average (Mexpressivity_external = 89.14, SD = 10.33). DISCUSSION Patients with chronic pain rate themselves as unimpaired in terms of their daily emotional awareness, expression, and regulation abilities. At the same time, mental health professionals rate these same individuals as significantly less emotionally competent. The question remains open as to what extent the divergent assessments can be explained by assessment bias.
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Affiliation(s)
- Anne Juliane Körner
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Rainer Sabatowski
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Lisa Burdic
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Linn Beyer
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Anne Gärtner
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Benjamin Schönbach
- Universitätsklinikum Carl Gustav Carus Dresden, UniversitätsSchmerzCentrum (USC), Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Ulrike Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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Lakha SF, Sohail SF, Holtzman CB, Akkok ZA, Khandwala A, Suhanic W, Pennefather P, Fels DI. Power of narrative: a case study about documenting private insightful experiences while dealing with pain and associated disability. Front Digit Health 2023; 5:1289373. [PMID: 38187187 PMCID: PMC10766838 DOI: 10.3389/fdgth.2023.1289373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Objective People adjusting to living with a chronic disability, such as chronic pain, seek support and resources from societal systems, including health systems, to help them cope with this reality. This case study describes the use of a digital health platform designed to help in that quest. Method MyHealthMyRecord (MHMR), is being developed to record, register and curate personal private experiences of a chronic condition. MHMR allows users to record and log short (30-90s) personal and private audio-videos of their accommodation-seeking journey in a way that can be encrypted, registered, curated and shared privately. This case study describes the use of a prototype version of the platform by a participant co-designer who experienced a sudden onset of a chronic pain condition, of undetermined origin. System use began three months after the onset of the condition and just after being discharged from several months of hospitalization without any definitive diagnosis. Result During a three-month period, 65 short unstructured contributions were authored and logged. This paper presents a qualitative analysis of that content. The clips used various communication styles that documented experiences, concerns, issues, positive and negative interactions and pain episodes. Using thematic analysis with open coding, three domains (person-facing, accessibility and system-facing) and eight themes (pain, joy, therapy, environmental, recommendations, technical, culture and communication) were identified. Comments about pain, stress, etc., were the most common and occurred in 75% of all videos while technical and therapy/physio related comments were the fewest and occurred in 3 and 9% of the videos, respectively. Conclusion We conclude that it is possible to create recordings of events, thoughts, reflections and issues on different aspects affecting an individual's health and well-being impact, including effects of the chronic condition as well as tangential outcomes such as accessibility (or lack of it), using MHMR over a longer period of time. The next steps will be to develop functionality to annotate the recordings, automatically analyze and summarize collections of recordings to make them consumable, useful and understandable to the individual and others, and then to share those analyses and summaries with others. In addition, evaluate this functionality longitudinally with more users.
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Affiliation(s)
- S. F. Lakha
- Inclusive Media and Design Centre, Ted Rogers School of information Technology Management, Toronto Metropolitan University, Toronto, ON, Canada
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - S. F. Sohail
- Inclusive Media and Design Centre, Ted Rogers School of information Technology Management, Toronto Metropolitan University, Toronto, ON, Canada
| | - C. B. Holtzman
- Inclusive Media and Design Centre, Ted Rogers School of information Technology Management, Toronto Metropolitan University, Toronto, ON, Canada
| | - Z. A. Akkok
- Inclusive Media and Design Centre, Ted Rogers School of information Technology Management, Toronto Metropolitan University, Toronto, ON, Canada
| | - A. Khandwala
- School of Administrative Studies, York University, Toronto, ON, Canada
| | | | - P. Pennefather
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- gDial Inc., Toronto, ON, Canada
| | - D. I. Fels
- Inclusive Media and Design Centre, Ted Rogers School of information Technology Management, Toronto Metropolitan University, Toronto, ON, Canada
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Vertsberger D, Talmon A, Ziadni M, Kong JT, Darnall BD, Manber R, Mackey S, Gross JJ. Intensity of Chronic Low Back Pain and Activity Interference: A Daily Diary Study of the Moderating Role of Cognitive Pain Coping Strategies. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:442-450. [PMID: 36214626 PMCID: PMC10069845 DOI: 10.1093/pm/pnac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Chronic low back pain (CLBP) has a significant negative impact on daily functioning, particularly for those with challenges coping adaptively with ongoing pain. However, the dynamics of pain coping in daily life remain understudied. Therefore, we examined the extent to which pain intensity interferes with daily activities, and assessed whether pain coping strategies (as assessed using daily diaries) moderated this link. METHOD We analyzed diary data from a sample of 84 participants with CLBP who completed daily diaries for up to 30 days rating pain intensity, pain interference with daily activities, and their use of pain coping strategies, including pain rumination (i.e., repetitive thinking about the pain and its causes), reappraisal (i.e., evaluating one's pain less negatively or more positively), and distraction (i.e., diverting attention from the pain). We hypothesized that these coping strategies would moderate the associations between pain and pain interference with daily activities, although in different directions. RESULTS Results suggest that pain rumination strengthens the association between pain intensity and pain interference both on the person and day level, while pain reappraisal and distraction weaken this association, at the day and person levels, respectively. CONCLUSION Our findings suggest that those who are more preoccupied with their pain and those who are less likely to reappraise their pain have more pain interference with daily activities. These findings build on prior work on pain coping by using daily diaries and highlight two pain coping strategies that have particular relevance for reducing the impact of CLBP in daily life.
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Affiliation(s)
- Dana Vertsberger
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Anat Talmon
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Maisa Ziadni
- Stanford Medicine, Stanford University, Stanford, California, USA
| | - Jiang-Ti Kong
- Stanford Medicine, Stanford University, Stanford, California, USA
| | - Beth D Darnall
- Stanford Medicine, Stanford University, Stanford, California, USA
| | - Rachel Manber
- Stanford Medicine, Stanford University, Stanford, California, USA
| | - Sean Mackey
- Stanford Medicine, Stanford University, Stanford, California, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, California, USA
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Miles SR, Martindale SL, Flanagan JC, Troyanskaya M, Reljic T, Gilmore AK, Wyant H, Nakase-Richardson R. Putting the pieces together to understand anger in combat veterans and service members: Psychological and physical contributors. J Psychiatr Res 2023; 159:57-65. [PMID: 36657315 DOI: 10.1016/j.jpsychires.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for the association between PTSD and anger, in addition to the association between pain interference and anger. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Additionally, treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference.
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Affiliation(s)
- Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Sarah L Martindale
- W.G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | - Maya Troyanskaya
- Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Tea Reljic
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Hannah Wyant
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Traumatic Brain Injury Center of Excellence, Defense Health Agency, James A. Haley Veterans' Hospital, Tampa, FL, USA; Pulmonary and Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
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Watanabe M, Tomiyama C, Nikaido T, Takeda T, Mandai N. Mental status is significantly associated with low back pain: a survey-based cross-sectional study among Japanese women. BMC Res Notes 2023; 16:8. [PMID: 36717870 PMCID: PMC9885655 DOI: 10.1186/s13104-023-06276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Low back pain (LBP) is a highly prevalent condition that poses significant patient burden. This cross-sectional study identified factors associated with LBP occurrence and developed a strategy to identify, prevent, and reduce LBP-related burden on patient health. A web-based questionnaire-answering system was used to assess the potential effects of LBP on mental health, assessing five domains (physical features, demographics, lifestyle, diet, and mental status) conceptually associated with hie, a common disease state traditionally described in the Japanese culture as a chilly sensation. RESULTS Of 1000 women, 354 had and 646 did not have LBP. The Chi test identified 21 factors, and subsequent multivariate logistic regression indicated eight factors significantly associated with LBP: age, history of physician consultation regarding anemia, history of analgesic agents, dietary limitations, nocturia, sauna use, hie, and fatigue. Furthermore, women with LBP exhibited a significantly lower body temperature (BT) in the axilla/on the forehead than women without LBP. LBP and hie are subjective and potentially affected by patient mental status. Stress reduces blood circulation, causing hypothermia and possibly worsening LBP. Therefore, mental-health support is important for patients with LBP to reduce physiological stress. Hyperthermia therapy, a traditionally prescribed intervention, is a potential intervention for future studies.
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Affiliation(s)
- Mayumi Watanabe
- grid.449550.90000 0004 0615 8394Faculty of Health Sciences, Kansai University of Health Sciences, Osaka, Japan ,grid.443595.a0000 0001 2323 0843Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Chikako Tomiyama
- grid.260975.f0000 0001 0671 5144Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Takuya Nikaido
- grid.411582.b0000 0001 1017 9540Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tokimasa Takeda
- grid.449550.90000 0004 0615 8394Faculty of Health Sciences, Kansai University of Health Sciences, Osaka, Japan ,grid.258799.80000 0004 0372 2033Zinbunken, Kyoto University, Kyoto, Japan
| | - Nozomu Mandai
- grid.460070.50000 0004 4666 2624Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan ,grid.411486.e0000 0004 1763 7219Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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Shaygan M, Jaberi A, Firozian R, Yazdani Z. Comparing the effects of multimedia and face-to-face pain management education on pain intensity and pain catastrophizing among patients with chronic low back pain: A randomized clinical trial. PLoS One 2022; 17:e0269785. [PMID: 35709207 PMCID: PMC9202919 DOI: 10.1371/journal.pone.0269785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Previous studies into Low Back Pain (LBP) assessed the effects of physical interventions or face-to-face (FTF) education mostly in western cultures. The present study aimed to compare the effects of multimedia and FTF pain management education (PME) on pain intensity and pain catastrophizing among participants with chronic LBP. Methods This double-blind randomized controlled clinical trial was conducted on ninety participants with chronic LBP randomly allocated to either multimedia, FTF, or control groups. Participants in the multimedia group received PME through watching seven educational CDs at home and their counterparts in the FTF group received the same educations in seven weekly FTF educational sessions. Pain intensity (using a numerical rating scale) and pain catastrophizing (using the Pain Catastrophizing Scale) were assessed before, immediately after, and one month after the study intervention. The effects of the interventions were assessed using the repeated-measures multivariate analysis of variance (MANOVA). Effect size and minimal detectable change (MDC) were reported for both variables. The regression model used in the present study was Generalized Estimating Equations (GEE). Findings The findings of MANOVA showed the significant effects of time on pain intensity and pain catastrophizing (P<0.001). The Tukey’s test showed that before and immediately after the intervention, the mean scores of pain intensity and pain catastrophizing in the FTF and PME groups were significantly different from the control group (P<0.001 and P = 0.001, respectively). MDC did not show clinically significant changes in the mean score of pain intensity and GEE revealed significant difference among the groups. Conclusion The findings suggested that multimedia PME is as effective as FTF education in reducing pain intensity and pain catastrophizing among participants with LBP. Future studies into the effects of education on LBP are recommended to consider longitudinal designs, a reliable cutoff score for pain catastrophizing, and participants’ physical ability. IRCT registration code IRCT20180313039074N1.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Jaberi
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- * E-mail:
| | - Roghayyeh Firozian
- Student Research Committee, Shiraz University of medical sciences, Shiraz, Iran
| | - Zahra Yazdani
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Harden RN, McCabe CS, Goebel A, Massey M, Suvar T, Grieve S, Bruehl S. Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:S1-S53. [PMID: 35687369 PMCID: PMC9186375 DOI: 10.1093/pm/pnac046] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/23/2022]
Abstract
There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for "better research." This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of "elder statesman" researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the "Budapest" criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.
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Affiliation(s)
- R Norman Harden
- Departments of PM&R and Physical Therapy and Human Movement Sciences, Northwestern University
| | - Candida S McCabe
- University of the West of England, Stapleton, Bristol, UK
- Dorothy House Hospice, Bradford-on-Avon, Wilts, UK
| | - Andreas Goebel
- Pain Research Institute, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Michael Massey
- CentraCare Neurosciences Pain Center, CentraCare, St. Cloud, Minnesota, USA
| | - Tolga Suvar
- Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sharon Grieve
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Centers, Nashville, Tennessee, USA
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11
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At the Intersection of Anger, Chronic Pain, and the Brain: A Mini-Review. Neurosci Biobehav Rev 2022; 135:104558. [PMID: 35122780 DOI: 10.1016/j.neubiorev.2022.104558] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 01/30/2023]
Abstract
Chronic pain remains one of the most persistent healthcare challenges in the world. To advance pain treatment, experts have recently introduced research-driven subtypes of chronic pain based on proposed underlying mechanisms. Nociplastic pain (e.g., nonspecific chronic low back or fibromyalgia) is one such subtype which may involve a greater etiologic role for brain plasticity, painful emotions induced by life stress and trauma, and unhealthy emotion regulation. In particular, correlational and behavioral data link anger and the ways anger is regulated with the presence and severity of nociplastic pain. Functional neuroimaging studies also suggest nociplastic pain and healthy anger regulation demonstrate inverse patterns of activity in the medial prefrontal cortex and amygdala; thus, improving anger regulation could normalize activity in these regions. In this Mini-Review, we summarize these findings and propose a unified, biobehavioral model called the Anger, Brain, and Nociplastic Pain (AB-NP) Model, which can be tested in future research and may advance pain care by informing new treatments that address anger, anger regulation, and brain plasticity for nociplastic pain.
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12
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Adachi T, Yamada K, Fujino H, Enomoto K, Shibata M. Associations between anger and chronic primary pain: a systematic review and meta-analysis. Scand J Pain 2022; 22:1-13. [PMID: 34908255 DOI: 10.1515/sjpain-2021-0154] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Anger is a negative emotion characterized by antagonism toward someone or something, is rooted in an appraisal or attribution of wrongdoing, and is accompanied by an action tendency to undo the wrongdoing. Anger is prevalent in individuals with chronic pain, especially those with chronic primary pain. The associations between anger and pain-related outcomes (e.g., pain intensity, disability) have been examined in previous studies. However, to our knowledge, no systematic review or meta-analysis has summarized the findings of anger-pain associations through a focus on chronic primary pain. Hence, we sought to summarize the findings on the associations of anger-related variables with pain and disability in individuals with chronic primary pain. METHODS All studies reporting at least one association between anger-related variables and the two pain-related outcomes in individuals with chronic primary pain were eligible. We searched electronic databases using keywords relevant to anger and chronic primary pain. Multiple reviewers independently screened for study eligibility, data extraction, and methodological quality assessment. RESULTS Thirty-eight studies were included in this systematic review, of which 20 provided data for meta-analyses (2,682 participants with chronic primary pain). Of the included studies, 68.4% had a medium methodological quality. Evidence showed mixed results in the qualitative synthesis. Most anger-related variables had significant positive pooled correlations with small to moderate effect sizes for pain and disability. CONCLUSIONS Through a comprehensive search, we identified several key anger-related variables associated with pain-related outcomes. In particular, associations with perceived injustice were substantial.
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Affiliation(s)
- Tomonori Adachi
- Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Keiko Yamada
- Department of Psychology, McGill University, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Haruo Fujino
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Kiyoka Enomoto
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
- Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Masahiko Shibata
- Department of Health Science, Naragakuen University, Nara, Nara, Japan
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13
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Koberskaya NN, Tabeeva GR. [A role of cognitive and emotional factors in formation of pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:111-118. [PMID: 34932296 DOI: 10.17116/jnevro2021121111111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pain is influenced by multiple emotional and cognitive factors. This paper provides an overview of the most important emotional and cognitive factors affecting pain, which has been confirmed in experimental and clinical studies. Emotional factors that increase pain perception include anxiety, depression, and other negative emotions. Positive emotions lead to a decrease in pain. Cognitive factors such as attention, expectation anxiety, and pain assessment can both increase and decrease pain sensations, depending on their specific focus. It becomes clear that pain is not just a reflection of nociceptive irritation, but also a feeling formed by psychological factors that can be individual in each case.
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Affiliation(s)
- N N Koberskaya
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - G R Tabeeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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14
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Post KM, Smith DA, Burns JW, Porter LS, Keefe FJ. A Dyadic Investigation of Depressed Affect and Interspousal Behavior in Couples With Chronic Back Pain. Ann Behav Med 2021; 56:1002-1013. [PMID: 34849529 DOI: 10.1093/abm/kaab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and marital discord are characteristic not only of individuals with chronic low back pain (ICPs) but also of their spouses. PURPOSE We examined actor-partner interdependence models to evaluate associations among depressed affect and criticism and support of partners at the same time point (concurrent effects) and 3 hr later (lagged effects). Fully dyadic models were used to account for both within-person and cross-spouse associations among depressed affect, criticism, and support for ICPs and spouses. We also examined the direction of the relationships (depressed affect predicting behavior and behavior predicting depressed affect) all while controlling for pain intensity, pain behavior, and the prior dependent variable. METHODS ICPs (n = 105) and their spouses completed electronic diary measures of depressed affect and behavior (criticism and support) five times a day for 2 weeks. Hierarchical linear modeling with person-mean centering was used for data analysis. RESULTS Within the same 3 hr epoch, more depressed affect was related to higher criticism and generally less support. Lagged analyses suggested bidirectional relationships between spouse's own depressed affect and spouse's own criticism of ICPs. Spouse depressed affect was also associated with decreased support received from ICPs. Pain behavior and pain intensity were also related to depressed affect, criticism, and support especially concurrently. CONCLUSIONS Theories and interventions need to address not only ICP depressed affect but also spouse depressed affect, as spouse depressed affect may be a stress generating precursor to criticism and support.
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Affiliation(s)
- Kristina M Post
- Department of Psychology, University of La Verne, 1950 Third Street, Hoover Building, La Verne, CA 91750, USA
| | - David A Smith
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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15
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Flynn DM, McQuinn H, Burke L, Steffen A, Fairchok A, Snow T, Doorenbos AZ. Use of Complementary and Integrative Health Therapies Prior to Intensive Functional Restoration in Active Duty Service Members with Chronic Pain. PAIN MEDICINE 2021; 23:844-856. [PMID: 34791423 DOI: 10.1093/pm/pnab326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Psychosocial factors are known to predict chronic pain, and the use of complementary and integrative health (CIH) therapies to address pain is emerging among military population. However, conflicting results on pain outcomes warrant additional research. This study aimed to (1) evaluate the benefit of adding a CIH pain management program to standard rehabilitative care (SRC), as compared to SRC alone, as precursor to an intensive functional restoration (FR) program; (2) identify factors that predict improvement in pain outcomes following treatment; and (3) determine the proportion of participants who experience clinically meaningful response. DESIGN Pragmatic randomized controlled clinical trial. Participants were randomized to a 3-week course of either SRC alone or SRC+CIH (stage 1), followed by a 3- to 6-week course of FR (stage 2). SETTING AND SUBJECTS Active duty service members with chronic pain. METHODS Participants completed either SRC alone or SRC+CIH (stage 1), followed by a course of FR (stage 2). Patient-reported and provider-determined outcomes were collected at baseline, after stage 1, and after stage 2. A covariance pattern model with unstructured residual covariance matrix was used to compare treatment arms while accounting for dependency due to repeated measurements. RESULTS A total of 210 service members participated. Most were Army (82%) and male (84%). Participants randomized to the SRC+CIH intervention had greater improvement in the pain impact score than those in the SRC alone group. Predictors of outcomes were baseline impact score, anger, depression, and educational status. CONCLUSIONS This study found that military service members with the highest pain impact benefit the most from interdisciplinary pain care.
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Affiliation(s)
| | | | - Larisa Burke
- College of Nursing, University of Illinois, Chicago, USA
| | - Alana Steffen
- College of Nursing, University of Illinois, Chicago, USA
| | | | - Tyler Snow
- Madigan Army Medical Center, Washington, USA
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
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16
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Metcalf O, Little J, Cowlishaw S, Varker T, Arjmand HA, O'Donnell M, Phelps A, Hinton M, Bryant R, Hopwood M, McFarlane A, Forbes D. Modelling the relationship between poor sleep and problem anger in veterans: A dynamic structural equation modelling approach. J Psychosom Res 2021; 150:110615. [PMID: 34525413 DOI: 10.1016/j.jpsychores.2021.110615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Problem anger and poor sleep are common, particularly in military and veteran populations, but the nature of the relationship is poorly understood, and treatment approaches would benefit from improved understanding of how these constructs interact. Ecological momentary assessment (EMA) is suitable for monitoring day-to-day fluctuations in symptoms, and modelling dynamic relationships between variables. METHODS This study aimed to examine these fluctuations and relationships involving sleep quality and anger experiences among veterans. A sample of n = 60 veterans with problem anger as assessed by the recommended cut off on the Dimensions of Anger Reactions 5 scale (DAR-5) completed daily assessments of sleep quality and four times daily assessments of anger frequency, over a 10-day period. RESULTS A Dynamic Structural Equation Model (DESM) estimated and revealed a unidirectional relationship across daily measurements, in that previous night poor sleep quality was associated with more frequent anger on the next day (φASi Estimate -0.791, one-tailed p = .075), but not the reverse. CONCLUSIONS These are the first longitudinal, naturalistic findings in relation to anger and sleep in a sample self-identifying with significant anger problems. The observed patterns point to the need for further research on mechanisms underpinning this relationship, and raises potential for early intervention for problem anger to include a focus on improving sleep quality.
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Affiliation(s)
- Olivia Metcalf
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia.
| | - Jonathon Little
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Sean Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Tracey Varker
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Hussain-Abdulah Arjmand
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Andrea Phelps
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Mark Hinton
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Richard Bryant
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Malcolm Hopwood
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Alexander McFarlane
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health, Centenary of Anzac Centre, Department of Psychiatry, University of Melbourne, Australia
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17
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Norman-Nott N, Wilks CR, Hesam-Shariati N, Schroeder J, Suh J, Czerwinski M, Briggs NE, Quidé Y, McAuley J, Gustin SM. The No Worries Trial: Efficacy of Online Dialectical Behaviour Therapy Skills Training for Chronic Pain (iDBT-Pain) Using A Single Case Experimental Design. THE JOURNAL OF PAIN 2021; 23:558-576. [PMID: 34678466 DOI: 10.1016/j.jpain.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022]
Abstract
Emotion dysregulation frequently co-occurs with chronic pain, which in turn leads to heightened emotional and physical suffering. This cycle of association has prompted a recommendation for psychological treatment of chronic pain to target mechanisms for emotion regulation. The current trial addressed this need by investigating a new internet-delivered treatment incorporating emotional skills training from dialectical behavioural therapy (DBT). Using a single-case experimental design that is suited to heterogeneous populations and can demonstrate efficacy with a small sample, three participants with chronic pain were recruited. Participants received four weeks of online DBT skills training (iDBT-Pain intervention) which incorporated one-on-one sessions over Zoom and a web app. Results revealed compelling evidence for the intervention on the primary outcome of emotion dysregulation and were promising for the secondary outcome of pain intensity. Improvement was also identified on pre-and post-measures of depression, coping behaviours, sleep problems, wellbeing, and harm avoidance, indicating that the intervention may positively influence other factors related to chronic pain. Overall, the trial provides preliminary efficacy for the intervention to improve chronic pain. However, we recommend further investigation of the iDBT-Pain intervention, either in single case trials, which when conducted with scientific rigour may be aggregated to derive nomothetic conclusions, or in a group-comparison trial to compare with usual modes of treatment. Perspective: This trial advances understanding of emotion-focused treatment for chronic pain and provides evidence for a viable new technological treatment. Importantly, as an internet-delivered approach, the iDBT-Pain intervention is accessible to those with restricted mobility and remote communities where there are often limited psychological services for people with chronic pain. Trial registration: The trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000604909).
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Affiliation(s)
- Nell Norman-Nott
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - Chelsey R Wilks
- Department of Psychological Science, University of Missouri-St Louis, United States
| | - Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - Jessica Schroeder
- School of Computer Science and Engineering, University of Washington, United States
| | - Jina Suh
- School of Computer Science and Engineering, University of Washington, United States; Microsoft Research, Redmond, United States
| | | | - Nancy E Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Yann Quidé
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - James McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia.
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18
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Miller MM, Williams AE, Scott EL, Trost Z, Hirsh AT. Anger as a Mechanism of Injustice Appraisals in Pediatric Chronic Pain. THE JOURNAL OF PAIN 2021; 23:212-222. [PMID: 34375744 DOI: 10.1016/j.jpain.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Abstract
Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, Mage=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain. Perspective: Anger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.
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Affiliation(s)
- Megan M Miller
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
| | - Amy E Williams
- Department of Psychiatry, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Eric L Scott
- Department of Pediatrics and Anesthesiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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19
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Wen CKF, Junghaenel DU, Newman DB, Schneider S, Mendez M, Goldstein SE, Velasco S, Smyth JM, Stone AA. The Effect of Training on Participant Adherence With a Reporting Time Frame for Momentary Subjective Experiences in Ecological Momentary Assessment: Cognitive Interview Study. JMIR Form Res 2021; 5:e28007. [PMID: 34037524 PMCID: PMC8190649 DOI: 10.2196/28007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Ecological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants’ adherence to the reporting instructions. Objective This study aims to investigate the reporting time frames participants used when answering EMA questions and whether participant training improves participants’ adherence to the EMA reporting timeframe instructions. Methods Telephone-based cognitive interviews were used to investigate the research questions. In a 2×2 factorial design, participants (n=100) were assigned to receive either basic or enhanced EMA training and randomized to rate their experiences using a momentary (at the moment you were called) or a coverage (since the last phone call) model. Participants received five calls over the course of a day to provide ratings; after each rating, participants were immediately interviewed about the time frame they used to answer the EMA questions. A total of 2 raters independently coded the momentary interview responses into time frame categories (Cohen κ=0.64, 95% CI 0.55-0.73). Results The results from the momentary conditions showed that most of the calls referred to the period during the call (57/199, 28.6%) or just before the call (98/199, 49.2%) to provide ratings; the remainder were from longer reporting periods. Multinomial logistic regression results indicated a significant training effect (χ21=16.6; P<.001) in which the enhanced training condition yielded more reports within the intended reporting time frames for momentary EMA reports. Cognitive interview data from the coverage model did not lend themselves to reliable coding and were not analyzed. Conclusions The results of this study provide the first evidence about adherence to EMA instructions to reporting periods and that enhanced participant training improves adherence to the time frame specified in momentary EMA studies.
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Affiliation(s)
- Cheng K Fred Wen
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Doerte U Junghaenel
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - David B Newman
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Stefan Schneider
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Marilyn Mendez
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Sarah E Goldstein
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Sarah Velasco
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Joshua M Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | - Arthur A Stone
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States.,Department of Psychology, University of Southern California, Los Angeles, CA, United States
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20
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Hass-Cohen N, Bokoch R, Goodman K, Conover KJ. Art therapy drawing protocols for chronic pain: Quantitative results from a mixed method pilot study. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2020.101749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Williams MT, Lewthwaite H, Fraysse F, Gajewska A, Ignatavicius J, Ferrar K. Compliance With Mobile Ecological Momentary Assessment of Self-Reported Health-Related Behaviors and Psychological Constructs in Adults: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e17023. [PMID: 33656451 PMCID: PMC7970161 DOI: 10.2196/17023] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/01/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023] Open
Abstract
Background Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults. Objective This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults. Methods In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P≤.05) assessed differences between nonclinical and clinical data sets. Results Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance. Conclusions In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation And Clinical Translation in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Hayley Lewthwaite
- Innovation, Implementation And Clinical Translation in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC, Canada
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Alexandra Gajewska
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jordan Ignatavicius
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Katia Ferrar
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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22
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Tung HY, Galloway J, Matcham F, Hotopf M, Norton S. High-frequency follow-up studies in musculoskeletal disorders: a scoping review. Rheumatology (Oxford) 2021; 60:48-59. [PMID: 33099639 DOI: 10.1093/rheumatology/keaa487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This scoping review identifies research in musculoskeletal disorders that uses high frequency follow-up of symptoms. The aim was to investigate whether symptom variability is investigated as a predictor of disease outcome and how intensive follow-up methods are used in musculoskeletal research. METHODS Embase, MEDLINE and PsycInfo were searched using OVID, and the Institute of Electrical and Electronic Engineers was also searched using the Institute of Electrical and Electronic Engineers Xplore search engine. Studies were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, but no meta-analysis was done because the priority in this study is to identify gaps in available literature. RESULTS Twenty-one papers were included. There was a mean of 54 patients per study (s.d. of 27.7). Two-thirds of the papers looked at how a symptom influences another in the short-term (subsequent assessment in the same day or next day), but none looked at the long-term. Only one study considered symptom variability investigating how higher variability in pain (defined by the s.d.) is associated with higher average pain severity and lower average sleep quality. CONCLUSION The methodology of musculoskeletal disorder research has changed from completing paper booklets to using electronic data capture (smartphones). There has also been a trend of collecting more intensive longitudinal data, but very little research utilizes these data to look at how symptom variability affects symptom outcomes. This demonstrates a gap in research where furthering understanding of this will help clinicians decide on the most important symptom to address in future patients.
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Affiliation(s)
- Hsiu Yen Tung
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience
| | - James Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences & Medicine
| | - Faith Matcham
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience.,Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences & Medicine
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23
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Burns JW, Janssen I, Lillis T, Mulcahy M, Purim-Shem-Tov YA, Bruehl S, Burgess HJ, Fischer A, Rim K, Aranda F, Pinkerton L, Hobfoll S. The transition from acute to persistent pain: the identification of distinct trajectories among women presenting to an emergency department. Pain 2020; 161:2511-2519. [PMID: 32569094 PMCID: PMC10853846 DOI: 10.1097/j.pain.0000000000001960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) symptoms and other negative psychosocial factors have been implicated in the transition from acute to persistent pain. Women (N = 375) who presented to an inner-city emergency department (ED) with complaints of acute pain were followed up for 3 months. They completed a comprehensive battery of questionnaires at an initial visit and provided ratings of pain intensity at the site of pain presented in the ED during 3 monthly phone calls. Latent class growth analyses were used to detect possible trajectories of change in pain intensity from the initial visit to 3 months later. A 3-trajectory solution was found, which identified 3 groups of participants. One group (early recovery; n = 93) had recovered to virtually no pain by the initial visit, whereas a second group (delayed recovery; n = 120) recovered to no pain only after 1 month. A third group (no recovery; n = 162) still reported elevated pain at 3 months after the ED visit. The no recovery group reported significantly greater PTSD symptoms, anger, sleep disturbance, and lower social support at the initial visit than both the early recovery and delayed recovery groups. Results suggest that women with high levels of PTSD symptoms, anger, sleep disturbance, and low social support who experience an acute pain episode serious enough to prompt an ED visit may maintain elevated pain at this pain site for at least 3 months. Such an array of factors may place women at an increased risk of developing persistent pain following acute pain.
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Affiliation(s)
- John W Burns
- Rush University Medical Center, Chicago, IL, United States
| | - Imke Janssen
- Rush University Medical Center, Chicago, IL, United States
| | - Teresa Lillis
- Rush University Medical Center, Chicago, IL, United States
| | - Morgan Mulcahy
- Rush University Medical Center, Chicago, IL, United States
| | | | - Stephen Bruehl
- Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | - Katie Rim
- University of Maryland, College Park MD, United States
| | - Frances Aranda
- University of Illinois at Chicago, Chicago, IL, United States
| | - Linzy Pinkerton
- Northwestern University, Feinberg School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stevan Hobfoll
- Star-Stress Anxiety and Resilience Consultants, Salt Lake City, UT, United States
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24
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Pinel L, Perez-Nieto MA, Redondo M, Rodríguez-Rodríguez L, Gordillo F, León L. Emotional affection on a sustained attention task: The importance the aging process and depression. PLoS One 2020; 15:e0234405. [PMID: 32598346 PMCID: PMC7323986 DOI: 10.1371/journal.pone.0234405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic pain is a complex experience that has now become a major public health issue. This has prompted many researchers to study attention, understanding it to be a crucial factor that allows altering the experience of pain, while attributing considerable importance to sustained attention. Accordingly, the main studies in this field stress the importance of emotion regulation processes and emotions on the perception of painful stimuli and attentional processes themselves. Nevertheless, only a handful of studies have been found that directly study the relationship between these variables. Within this context, this article sets out to analyse emotional regulation processes, emotional variables (depression and anxiety), the experience of pain, and age on the ability to maintain the vigilance response in a sample of patients with chronic pain. This involved selecting a sample of 49 patients with rheumatoid arthritis and examining their performance in an ad-hoc sustained attention test. With a view to complying with the study's main purpose, the participants were also assessed through the use of the following self-report measures: the Beck Depression Inventory (BDI-I); the Hospital Anxiety and Depression Scale (HADS); the McGill Pain Questionnaire, and the Difficulties in Emotion Regulation Scale (DERS). Linear regression analyses revealed a significant impact of the aging process on the performance times in the attention task. Likewise, age and depression recorded a significant correlation with the mistakes made during the task. These results suggest that higher depression levels and an older age might be related to a worse adaptation to pain management techniques based on attention processes, such as mindfulness.
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Affiliation(s)
- Luis Pinel
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Marta Redondo
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
| | | | - Fernando Gordillo
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
| | - Leticia León
- Department of Education and Health, Camilo José Cela University, Madrid, Spain
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25
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Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial. PAIN MEDICINE 2020; 21:2811-2822. [DOI: 10.1093/pm/pnaa145] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Objective
Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain.
Design
Randomized comparison trial.
Setting
Outpatient clinics at the West Los Angeles VA Medical Center.
Subjects
Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain.
Methods
Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up.
Results
EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance.
Conclusions
This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.
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26
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Marini CM, Martire LM, Jones DR, Zhaoyang R, Buxton OM. Daily Links Between Sleep and Anger Among Spouses of Chronic Pain Patients. J Gerontol B Psychol Sci Soc Sci 2020; 75:927-936. [PMID: 30285248 DOI: 10.1093/geronb/gby111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study identified daily associations between sleep, emotion, and marital functioning in the context of chronic pain. Because spouses' sleep is compromised on nights when patients experience more pain, we set out to identify implications of spouses' sleep for their own emotion (anger) upon waking and marital interaction (marital tension) throughout the rest of the day. We further considered whether spouses' critical attitudes about patients' pain-related coping exacerbated associations between their sleep, morning anger, and marital tension. METHOD Data came from a study of knee osteoarthritis patients (50+ years old) and spouses (N = 138 couples) who completed daily diaries across 22 days. Multilevel models were estimated to test hypotheses. RESULTS Spouses woke up angrier on mornings when they reported that their sleep was more unrefreshing than usual. This association was stronger among more critical spouses. Morning anger resulting from unrefreshing sleep, however, did not predict marital tension throughout the rest of the day. DISCUSSION Findings highlight the potential value of intervention efforts aimed at promoting spouses' sleep quality in an effort to offset negative emotional consequences that may undermine spouses' and patients' adjustment in the context of chronic pain.
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Affiliation(s)
| | - Lynn M Martire
- Center for Healthy Aging, Pennsylvania State University.,Department of Human Development and Family Studies, Pennsylvania State University
| | - Dusti R Jones
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University
| | | | - Orfeu M Buxton
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University
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27
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Pazzaglia F, Moè A, Cipolletta S, Chia M, Galozzi P, Masiero S, Punzi L. Multiple Dimensions of Self-Esteem and Their Relationship with Health in Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2616. [PMID: 32290357 PMCID: PMC7215662 DOI: 10.3390/ijerph17082616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to examine how different domains of self-esteem (social, competence, affect, academic, family, and physical) relate to self-reported physical and mental health, lower back pain (LBP), smoking, and physical exercise in a sample of adolescents. A sample of 326 adolescents 14-19 years old completed several self-report questionnaires collecting epidemiological data, and information on their LBP, smoking, and physical exercise, the Short Form Health Survey (SF-36), and the Multidimensional Self-Concept Scale. Pearson's correlations were calculated between their self-esteem scores and their physical and mental health scores. Three multivariate analyses of variance (MANOVAs) were performed to estimate associations between self-esteem and LBP, smoking, and physical exercise. Self-esteem (total and subcomponent scores) correlated positively with physical and mental health, and with physical exercise, and negatively with smoking. The results also confirm gender-related differences in self-esteem, in favor of boys. This study offers the first findings on the relationship between different domains of self-esteem and a variety of health outcomes in an adolescent population. The results suggest that multidimensional interventions could be devised to improve adolescents' physical health by promoting their physical exercise, and to prevent their smoking by nurturing their self-esteem.
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Affiliation(s)
- Francesca Pazzaglia
- Department of General Psychology, University of Padova, 35131 Padova, Italy
- Health and Motion Venice Association (HEMOVE), 30122 Venice, Italy
| | - Angelica Moè
- Department of General Psychology, University of Padova, 35131 Padova, Italy
| | - Sabrina Cipolletta
- Department of General Psychology, University of Padova, 35131 Padova, Italy
- Health and Motion Venice Association (HEMOVE), 30122 Venice, Italy
| | - Monica Chia
- Health and Motion Venice Association (HEMOVE), 30122 Venice, Italy
| | - Paola Galozzi
- Health and Motion Venice Association (HEMOVE), 30122 Venice, Italy
- Department of Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Stefano Masiero
- Department of Neuroscience, Rehabilitation Unit, University of Padova, 35128 Padova, Italy
| | - Leonardo Punzi
- Health and Motion Venice Association (HEMOVE), 30122 Venice, Italy
- Center for Gout and Metabolic Bone and Joint Diseases, Rheumatology, SS Giovanni and Paolo Hospital, 30122 Venice, Italy
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28
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Gerhart J, Duberstein P, Paull D, O'Mahony S, Burns J, DeNicolo M, Hoerger M. Geopersonality of Preventable Death in the United States: Anger-Prone States and Opioid Deaths. Am J Hosp Palliat Care 2020; 37:624-631. [PMID: 32008364 DOI: 10.1177/1049909120902808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Opioid overdoses have reached epidemic levels in the United States and have clustered in Northeastern and "Rust Belt" states. Five Factor Model (FFM) personality traits also vary at the state level, with anger-prone traits clustered in the Northeast region. This study tested the hypothesis that state-level anger proneness would be associated with a greater increase in rates of opioid overdose death. METHODS This was a secondary analysis of state-level data on FFM traits, opioid overdose deaths, and other classes of preventable death. Robust mixed models tested whether change in rates of opioid overdose death from 2008 to 2016 was moderated by state-level anger proneness. RESULTS State-level anger proneness was significantly associated with greater increases in rates of opioid overdose deaths (B = 1.01, standard error = 0.19, P < .001, 95% confidence interval: 0.63-1.39). The slope of increase in opioid overdose death rates was 380% greater in anger-prone states and held after adjustment for potential confounders such as state-level prevalence of major depressive disorder, number of mental health facilities, and historical patterns of manufacturing decline. A similar pattern was observed between state-level anger proneness and benzodiazepine overdose deaths but was not significant for the latter after adjustment for potential confounders. CONCLUSION These findings suggest that states characterized as more anger prone have experienced greater increases in opioid overdose deaths.
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Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, MI, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers University School of Public Health, New Brunswick, NJ, USA
| | - Danielle Paull
- Department of Psychology, Central Michigan University, MI, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Palliative Medicine Service, Rush University Medical Center, Chicago, IL, USA
| | - John Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA, USA
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29
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Ouchi K, Watanabe M, Tomiyama C, Nikaido T, Oh Z, Hirano T, Akazawa K, Mandai N. Emotional Effects on Factors Associated with Chronic Low Back Pain. J Pain Res 2019; 12:3343-3353. [PMID: 31908519 PMCID: PMC6925544 DOI: 10.2147/jpr.s223190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Although chronic low back pain (CLBP) has profound effects on patients, society, and economy, its causes are difficult to identify. Psychogenic effects or social stress is known to affect CLBP; hence, investigation of its underlying causes requires a multifactorial approach. We determined the factors associated with CLBP by using an Internet-based survey. To prevent CLBP, we need to understand its cause and background. PATIENTS AND METHODS A total of 1000 participants either with (+) or without (-) CLBP answered the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), which assesses five domains of CLBP: low back pain, lumbar function, walking ability, social life function and mental health. We also administered a new questionnaire for participants, that comprised five different domains: Body, Lifestyle, Emotion, Diet, and Social. To evaluate psychogenic effects on CLBP, we added two original factors, namely outshout and HIE, which have not yet been studied. HIE is a traditional concept (sense) of "feeling cold" or "chilly." All participants completed both questionnaires. RESULTS Multivariate logistic regression analysis extracted four factors (sleep, room temperature, outshout, and HIE) that were associated with CLBP. The mental health domain was assessed using the JOABPEQ for each of these factors. The factors outshout and HIE differed between CLBP (+) and CLBP (-) patients. CLBP (-) participants also showed a difference in Sleep and HIE factors. CONCLUSION Among psychogenic effects, Emotion was common to all the four extracted factors. There was no common physical divisor. Therefore, we hypothesized that acute low back pain might develop into CLBP in the presence of psychological stress or other emotional factors such as outshout or HIE. Hence, we need to consider both physical and psychogenic effects in the prevention and treatment of CLBP. Furthermore, appropriate evaluation and treatment of psychological stress may be effective in reducing CLBP.
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Affiliation(s)
- Koichi Ouchi
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Mayumi Watanabe
- Faculty of Health Sciences, Kansai University of Health Sciences, Osaka, Japan
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Chikako Tomiyama
- Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Zaigen Oh
- Faculty of Health Sciences, Kansai University of Health Sciences, Osaka, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Nozomu Mandai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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30
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Goodlev ER, Discala S, Darnall BD, Hanson M, Petok A, Silverman M. Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship. J Palliat Med 2019; 22:1308-1317. [PMID: 31329500 DOI: 10.1089/jpm.2019.0171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Eric R. Goodlev
- Division of Geriatrics and Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sandra Discala
- West Palm Beach Veterans Affairs Medical Center, West Palm Beach, Florida
| | - Beth D. Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Molly Hanson
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alison Petok
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Silverman
- West Palm Beach Veterans Affairs Medical Center, West Palm Beach, Florida
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31
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Sommer I, Lukic N, Rössler W, Ettlin DA. Measuring anger in patients experiencing chronic pain - A systematic review. J Psychosom Res 2019; 125:109778. [PMID: 31442843 DOI: 10.1016/j.jpsychores.2019.109778] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/03/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
Anger is prevalent in chronic pain and has been associated with pain perception, disability, behavior and treatment outcome. Objectives were (1) to survey in the context of chronic pain the application (and omission) of validated anger self-report instruments, (2) to discuss the instruments found in the context of emotion theories and (3) to identify a possible instrument preference. A systematic search of textbooks and review articles was first performed on validated instruments designed to measure the cognitive, the motivational and the subjective feeling component of anger. Thereafter, a systematic review aimed at finding chronic pain studies from 2005 to 2019 reporting on these instruments. Textbooks and reviews listed 16 validated self-report anger measurement instruments. 28 papers applying four of these were identified and two new instruments were additionally detected. The State-Trait Anger Expression (STAXI) and its precursors were most commonly used. Studies on chronic low back pain patients prevailed. In conclusion, anger in chronic pain patients is reliably measurable at low cost with self-report tools. The STAXI-II qualifies best for this purpose based on its extensive validation history. The majority of instruments lack sufficient theoretical and psychometric adequacy. A more detailed exploration of the cognitive anger component in chronic pain patients in future research is recommended.
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Affiliation(s)
- Isabelle Sommer
- Interdisciplinary Orofacial Pain Unit, Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland
| | - Nenad Lukic
- Interdisciplinary Orofacial Pain Unit, Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland; Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany; Institute of Psychiatry, Laboratory of Neuroscience, University of São Paulo, São Paulo, Brazil
| | - Dominik A Ettlin
- Interdisciplinary Orofacial Pain Unit, Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland; São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil.
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32
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Rausa M, Cevoli S, Giannini G, Favoni V, Contin SA, Zenesini C, Ballardini D, Cortelli P, Pierangeli G. State and trait anger and its expression in cluster headache compared with migraine: a cross-sectional study. Neurol Sci 2019; 40:2365-2370. [PMID: 31254182 DOI: 10.1007/s10072-019-03987-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anger is involved in the emotional experience of pain. Individuals with migraine are more likely to hold their anger-in than controls. However, only one study evaluated anger in cluster headache (CH). The objective is to compare anger between migraine and CH patients. METHODS One hundred thirty-five migraine and 108 CH patients completed the State Trait Anger Expression Inventory (STAXI-2), composed of 7 subscales. State Anger measures the intensity of the individual's angry feelings at the time of testing. Trait Anger evaluates general predisposition to become angry. Anger Expression Out and Anger Expression In measure the extent to which anger could be overtly expressed or suppressed. Anger Control Out and Anger Control In evaluate how individual try to control the outward or inward expression of anger. Anger Expression Index is a general index. RESULTS CH patients have higher median scores than migraine patients in State Anger (46 vs 44, p = 0.012). CH patients have lower scores in Anger Control Out (44 vs 50, p = 0.016). In subgroup analysis, CH patients during the cluster period have higher scores than chronic migraine patients in State Anger (47 vs 44, p = 0.035), while CH patients in headache-free period did not differ from migraine patients. CONCLUSIONS Migraine and CH patients differ in state anger, indicating that CH patients experienced higher intensity of anger during the time of testing. These data add new information about emotional regulation in headache patients and could support the hypothesis of different emotional and behavioral responses to pain in migraine and CH patients.
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Affiliation(s)
- Marialuisa Rausa
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Via Altura 3, 40100, Bologna, Italy. .,Centro Gruber, Diagnosis and Treatment Center of Eating and Weight Disorders, Diagnosis and Treatment of Anxiety and Psychosomatic Disorders, Via Santo Stefano, 10, 40100, Bologna, Italy.
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40100, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Via Altura 3, 40100, Bologna, Italy
| | - Valentina Favoni
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Via Altura 3, 40100, Bologna, Italy
| | - Sara Anastasia Contin
- Centro Gruber, Diagnosis and Treatment Center of Eating and Weight Disorders, Diagnosis and Treatment of Anxiety and Psychosomatic Disorders, Via Santo Stefano, 10, 40100, Bologna, Italy
| | - Corrado Zenesini
- Neuroepidemiology Research Unit, Servizio di Epidemiologia e Biostatistica, IRCCS-Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40100, Bologna, Italy
| | - Donatella Ballardini
- Centro Gruber, Diagnosis and Treatment Center of Eating and Weight Disorders, Diagnosis and Treatment of Anxiety and Psychosomatic Disorders, Via Santo Stefano, 10, 40100, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Via Altura 3, 40100, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40100, Bologna, Italy
| | - Giulia Pierangeli
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Via Altura 3, 40100, Bologna, Italy.,Centro Gruber, Diagnosis and Treatment Center of Eating and Weight Disorders, Diagnosis and Treatment of Anxiety and Psychosomatic Disorders, Via Santo Stefano, 10, 40100, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40100, Bologna, Italy
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Okur Güney ZE, Sattel H, Witthöft M, Henningsen P. Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PLoS One 2019; 14:e0217277. [PMID: 31173599 PMCID: PMC6555516 DOI: 10.1371/journal.pone.0217277] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD. Objectives This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies. Data sources PsycINFO and PubMed databases for the articles published between January 1985 and June 2018. Search terms “emotion/al regulation” or “affect regulation” and various forms of SSD. Study eligibility criteria Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included. Study synthesis methods A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge). Results The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material. Limitations There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous. Conclusions and implications Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.
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Affiliation(s)
- Zeynep Emine Okur Güney
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
- * E-mail:
| | - Heribert Sattel
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| | - Michael Witthöft
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
| | - Peter Henningsen
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
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Variability in negative emotions among individuals with chronic low back pain: relationships with pain and function. Pain 2019; 159:342-350. [PMID: 29140926 DOI: 10.1097/j.pain.0000000000001102] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic pain is associated with elevated negative emotions, and resources needed to adaptively regulate these emotions can be depleted during prolonged pain. Studies of links between pain, function, and negative emotions in people with chronic pain, however, have focused almost exclusively on relationships among mean levels of these factors. Indexes that may reflect aspects of emotion regulation have typically not been analyzed. We propose that 1 index of emotion regulation is variability in emotion over time as opposed to average emotion over time. The sample was 105 people with chronic low back pain and 105 of their pain-free spouses. They completed electronic diary measures 5x/d for 14 consecutive days, producing 70 observations per person from which we derived estimates of within-subject variance in negative emotions. Location-scale models were used to simultaneously model predictors of both mean level and variance in patient negative emotions over time. Patients reported significantly more variability in negative emotions compared to their spouses. Patients who reported higher average levels of pain, pain interference, and downtime reported significantly higher levels of variability in negative emotions. Spouse-observed pain and pain behaviors were also associated with greater variability in patients' negative emotions. Test of the inverse associations between negative emotion level and variability in pain and function were significant but weaker in magnitude. These findings support the notion that chronic pain may erode negative emotion regulation resources, to the potential detriment of intra- and inter-personal function.
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Darnall BD, Colloca L. Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:129-157. [PMID: 30146045 PMCID: PMC6175287 DOI: 10.1016/bs.irn.2018.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.
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Affiliation(s)
- Beth D Darnall
- School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Psychiatry and Behavioral Sciences (by courtesy), Stanford University, Palo Alto, CA, United States.
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States
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May M, Junghaenel DU, Ono M, Stone AA, Schneider S. Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review. THE JOURNAL OF PAIN 2018; 19:699-716. [PMID: 29371113 PMCID: PMC6026050 DOI: 10.1016/j.jpain.2018.01.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 01/11/2023]
Abstract
Self-reported pain intensity assessments are central to chronic pain research. Ecological momentary assessment (EMA) methodologies are uniquely positioned to collect these data, and are indeed being used in the field. However, EMA protocols are complex, and many decisions are necessary in the design of EMA research studies. A systematic literature review identified 105 articles drawing from 62 quantitative EMA research projects examining pain intensity in adult chronic pain patients. Study characteristics were tabulated to summarize and describe the use of EMA, with an emphasis placed on various dimensions of decision-making involved in executing EMA methodologies. Most identified studies considered within-person relationships between pain and other variables, and a few examined interventions on chronic pain. There was a trend toward the use of smartphones as EMA data collection devices more recently, and completion rates were not reported in nearly one third of studies. Pain intensity items varied widely with respect to number of scale points, anchor labels, and length of reporting period; most used numeric rating scales. Recommendations are provided for reporting to improve reproducibility, comparability, and interpretation of results, and for opportunities to clarify the importance of design decisions. PERSPECTIVE Studies that use EMA methodologies to assess pain intensity are heterogeneous. Aspects of protocol design, including data input modality and pain item construction, have the potential to influence the data collected. Thorough reporting on design features and completion rates therefore facilitates reproducibility, comparability, and interpretation of study results.
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Affiliation(s)
- Marcella May
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California.
| | - Doerte U Junghaenel
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Masakatsu Ono
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Arthur A Stone
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Stefan Schneider
- Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, Los Angeles, California
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Fernandez E, Kiageri V, Guharajan D, Day A. Anger parameters in parolees undergoing psychoeducation: Temporal stability, social desirability bias, and comparison with non-offenders. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:174-186. [PMID: 28884849 DOI: 10.1002/cbm.2057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Anger is commonly measured as if it were a single, simple construct. This may be particularly unhelpful if the main purpose of a measure is to determine change and responsiveness to interventions. AIMS Our primary aim was to assess five anger parameters in parolees - frequency, duration, intensity, latency, and threshold - and to test for effects of psychoeducation and social desirability bias on parolees' scores. Average anger scores for the offender sample were compared with those in a non-offender sample. METHODS The offender sample was drawn from male parolees in San Antonio. Age-matched volunteers recruited at public libraries were engaged for baseline comparisons. The Anger Parameters Scale and the Marlow-Crowne Scale were used to assess anger and social desirability, respectively. Parole officers delivered a psychoeducation course to parolees over 12 weeks, and anger and social desirability measures were taken before and afterwards. RESULTS At baseline, parolees were angry more often, stayed angry longer, and reached higher levels of anger than the non-offenders, confirming their eligibility for the programme. Mean anger scores were not significantly different after psychoeducation than before it. Parolees' reported anger was significantly and negatively correlated with social desirability scores. CONCLUSIONS Only three of the five anger parameters were prominent among these offenders: frequency, duration, and intensity of their outbursts. Psychoeducation did not produce improvement, possibly because it was instructional rather than therapeutic, but also because group means may mask useful individual differences. Concurrent assessment of social desirability is likely to assist in interpretation of anger measures. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ephrem Fernandez
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Vasiliki Kiageri
- Older Adult Psychology, Dudley and Walsall Mental Health Partnership NHS Trust, Dudley, UK
| | - Deepan Guharajan
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Andrew Day
- Indigenous Education & Research Centre, James Cook University, Townsville, QLD, Australia
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Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. The role of emotion regulation in chronic pain: A systematic literature review. J Psychosom Res 2018; 107:38-45. [PMID: 29502762 DOI: 10.1016/j.jpsychores.2018.02.002] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Emotion regulation (ER) includes a set of cognitive and attentional processes used to change or maintain emotional state. A small but growing body of research suggests that maladaptive ER might be a risk factor for the development of chronic pain. This review aims to summarize existing literature on the association between ER and chronic pain, and to determine whether the construct of ER may further enhance our understanding of the risk and protective factors that may contribute to the onset and maintenance of chronic pain. METHODS A systematic search was conducted using the search terms "chronic pain" and "emotion regulation." Studies that measured both constructs across all age groups were included. RESULTS We found 15 studies that met our inclusion criteria. Nine studies were completed within the last five years, suggesting that the evaluation of ER as it relates to pain is a new line of research. Studies that measured "response-focused" ER found associations between maladaptive ER and pain. Studies that measured "antecedent-focused" ER strategies were less likely to show a direct association with pain. CONCLUSION Maladaptive response-focused ER may be an important risk factor in the development and maintenance of chronic pain, as it is associated with pain and psychological comorbidities. Adding ER to chronic pain investigations may help to further explain individual differences in the risk and protective mechanisms that are known to influence chronic pain. Importantly, this line of research has potential to directly inform future interventions for patients with chronic pain.
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Affiliation(s)
- Helen Koechlin
- Department of Clinical Psychology & Psychotherapy, University of Basel, Switzerland; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA.
| | - Rachael Coakley
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Neil Schechter
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | | | - Joe Kossowsky
- Department of Clinical Psychology & Psychotherapy, University of Basel, Switzerland; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
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21st Century Cognitive Behavioural Therapy for Anger: A Systematic Review of Research Design, Methodology and Outcome. Behav Cogn Psychother 2018; 46:385-404. [DOI: 10.1017/s1352465818000048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:Past reviews of cognitive behavioural therapy (CBT) for anger have focused on outcome in specific subpopulations, with few questions posed about research design and methodology. Since the turn of the century, there has been a surge of methodologically varied studies awaiting systematic review.Aims:The basic aim was to review this recent literature in terms of trends and patterns in research design, operationalization of anger, and covariates such as social desirability bias (SDB). Also of interest was clinical outcome.Method:After successive culling, 42 relevant studies were retained. These were subjected to a rapid evidence assessment (REA) with special attention to design (ranked on the Scientific Methods Scale) measurement methodology (self-monitored behaviour, anger questionnaires, and others’ ratings), SDB assessment, and statistical versus clinical significance.Results:The randomized controlled trial characterized 60% of the studies, and the State Trait Anger Expression Inventory was the dominant measure of anger. All but one of the studies reported statistically significant outcome, and all but one of the 21 studies evaluating clinical significance laid claim to it. The one study with neither statistical nor clinical significance was the only one that had assessed and corrected for SDB.Conclusions:Measures remain relatively narrow in scope, but study designs have improved, and the outcomes suggest efficacy and clinical effectiveness. In conjunction with previous findings of an inverse relationship between anger and SDB, the results raise the possibility that the favourable picture of CBT for anger may need closer scrutiny with SDB and other methodological details in mind.
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Hanssen MM, Peters ML, Boselie JJ, Meulders A. Can positive affect attenuate (persistent) pain? State of the art and clinical implications. Curr Rheumatol Rep 2017; 19:80. [PMID: 29119260 PMCID: PMC5683052 DOI: 10.1007/s11926-017-0703-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose of Review Pain is an intense experience that can place a heavy burden on peoples’ lives. The identification of psychosocial risk factors led to the development of effective pain treatments. However, effect sizes are modest. Accumulating evidence suggests that enhancing protective factors might also impact on (well-being despite) pain. Recent findings on positive affect (interventions) towards pain-related outcomes will be reviewed, and new avenues for treatment of persistent pain will be discussed. Recent Findings Positive affect significantly attenuates the experience of pain in healthy and clinical populations. Positive affect interventions effectively reduce pain sensitivity and bolster well-being despite pain. Through both psychological and (neuro-)biological pathways, but also through its effect on central treatment processes such as inhibitory learning, positive affect can optimize the efficacy of existing treatments. Summary Comprehensive understanding of the unique roles and dynamic interplay of positive and negative affect in moderating pain may optimize the treatment of (persistent) pain.
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Affiliation(s)
- Marjolein M Hanssen
- Clinical Psychological Science, Research Group Behavioral Medicine, Maastricht University, P.O. 616, 6200 MD, Maastricht, The Netherlands
| | - Madelon L Peters
- Clinical Psychological Science, Research Group Behavioral Medicine, Maastricht University, P.O. 616, 6200 MD, Maastricht, The Netherlands
| | - Jantine J Boselie
- Clinical Psychological Science, Research Group Behavioral Medicine, Maastricht University, P.O. 616, 6200 MD, Maastricht, The Netherlands
| | - Ann Meulders
- Clinical Psychological Science, Research Group Behavioral Medicine, Maastricht University, P.O. 616, 6200 MD, Maastricht, The Netherlands. .,Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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Pain and multiple facets of anger and hostility in a sample seeking treatment for problematic anger. Psychiatry Res 2017; 253:311-317. [PMID: 28412614 DOI: 10.1016/j.psychres.2017.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/08/2017] [Accepted: 04/02/2017] [Indexed: 11/23/2022]
Abstract
A number of studies have reported associations between pain and anger in samples with chronic pain, but research has mostly overlooked associations between pain and anger in those with problematic anger. The present study explored associations between pain severity and a variety of anger and hostility constructs in a sample seeking anger treatment (n =131). Zero-order correlations and partial correlations were used to examine associations between pain, anger, and hostility, controlling for depressive symptoms. Hierarchical regression models examined potential interaction effects of gender on associations between pain and these outcomes. Pain severity was positively associated with trait anger, outward anger expression, hostile interpretation bias, hostile ideation, and inability to forgive others. These associations were independent of co-occurring depressive symptoms, with some exceptions. Gender moderated the association between pain and hostile ideation such that pain was positively associated with hostile ideation in women but not men. Pain severity was uniquely associated with multiple outcomes of relevance to individuals undergoing treatment for problematic anger. Clinical implications will be discussed.
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Crane CA, Easton CJ. Physical Health Conditions and Intimate Partner Violence Perpetration Among Offenders With Alcohol Use Diagnoses. JOURNAL OF INTERPERSONAL VIOLENCE 2017; 32:1678-1691. [PMID: 26058979 PMCID: PMC4798908 DOI: 10.1177/0886260515590124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Intimate partner violence (IPV) is prevalent among samples with diagnosed alcohol use disorders (AUDs), but few studies have evaluated the factors that account for this increased risk, and none have systematically evaluated the risk posed by comorbid physical health conditions. The present study evaluated the likelihood of perpetrating IPV among alcohol diagnosed offenders with medical health problems relative to healthy counterparts. Physical health and partner violence data provided by 655 criminal offenders with AUDs diagnosed during a court-ordered substance abuse evaluation were examined. One third of participants (35.3%) endorsed a physical health condition, and 46.4% reported perpetrating physical IPV. The odds of perpetrating IPV among participants with a physical health condition were 2.29 times larger than among healthy participants. Specific conditions emerged as risk factors for IPV, including brain injury, cardiac issues, chronic pain, liver issues, gastrointestinal symptoms, hepatitis, and recent injury. Findings highlight the importance of identifying and managing physical health conditions that may complicate IPV treatment efforts. Integrated behavioral and medical health treatment approaches may increase treatment compliance and reduce the risk of future partner violence among offenders with co-occurring issues, such as mental illness, addiction, and physical health conditions.
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Affiliation(s)
- Cory A Crane
- 1 Yale University School of Medicine, New Haven, CT, USA
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Langer SL, Romano JM, Liu Q, Levy RL, Nielson H, Brown JD. Pain catastrophizing predicts verbal expression among children with chronic pain and their mothers. Health Psychol Open 2017; 3:2055102916632667. [PMID: 28070387 PMCID: PMC5193312 DOI: 10.1177/2055102916632667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study examined intra- and inter-personal associations between pain catastrophizing and verbal expression in 70 children with recurrent abdominal pain and their mothers. Participants independently completed the Pain Catastrophizing Scale. Mothers and children then talked about the child’s pain. Speech was categorized using a linguistic analysis program. Catastrophizing was positively associated with the use of negative emotion words by both mothers and children. In addition, mothers’ catastrophizing was positively associated with both mothers’ and children’s anger word usage, whereas children’s catastrophizing was inversely associated with mothers’ anger word usage. Findings extend the literature on behavioral and interpersonal aspects of catastrophizing.
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Russell MA, Smith TW, Smyth JM. Anger Expression, Momentary Anger, and Symptom Severity in Patients with Chronic Disease. Ann Behav Med 2016; 50:259-71. [PMID: 26493555 DOI: 10.1007/s12160-015-9747-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Anger expression styles are associated with physical health, and may affect health by modulating anger experience in daily life. Research examining this process in the daily lives of clinically relevant populations, such as patients with chronic disease, is needed. METHOD Community adults with asthma (N = 97) or rheumatoid arthritis (RA; N = 31) completed measures of trait-level anger expression styles (anger-in and anger-out), followed by ecological momentary assessments of anger and physical health five times daily for 7 days. RESULTS High anger-in predicted greater momentary anger, physical limitations, and greater asthma symptoms. High anger-out predicted reduced RA symptoms. Momentary anger was robustly associated with more severe symptoms in daily life. Three-way interactions showed that anger-in moderated these momentary anger-symptom associations more consistently in men. CONCLUSIONS Anger expression styles, particularly anger-in, may affect the day-to-day adjustment of patients with chronic disease in part by altering the dimensions of everyday anger experience, in ways that appear to differ by gender.
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Affiliation(s)
| | | | - Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University, #231 Biobehavioral Health Building, University Park, PA, 16802, USA.
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Jasinski MJ, Lumley MA, Latsch DV, Schuster E, Kinner E, Burns JW. Assessing Anger Expression: Construct Validity of Three Emotion Expression-Related Measures. J Pers Assess 2016; 98:640-8. [PMID: 27248355 PMCID: PMC5053333 DOI: 10.1080/00223891.2016.1178650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-report measures of emotional expression are common, but their validity to predict objective emotional expression, particularly of anger, is unclear. We tested the validity of the Anger Expression Inventory (AEI; Spielberger et al., 1985 ), Emotional Approach Coping Scale (EAC; Stanton, Kirk, Cameron, & Danoff-Burg, 2000 ), and Toronto Alexithymia Scale-20 (TAS-20; Bagby, Taylor, & Parker, 1994 ) to predict objective anger expression in 95 adults with chronic back pain. Participants attempted to solve a difficult computer maze by following the directions of a confederate who treated them rudely and unjustly. Participants then expressed their feelings for 4 min. Blinded raters coded the videos for anger expression, and a software program analyzed expression transcripts for anger-related words. Analyses related each questionnaire to anger expression. The AEI Anger-Out scale predicted greater anger expression, as expected, but AEI Anger-In did not. The EAC Emotional Processing scale predicted less anger expression, but the EAC Emotional Expression scale was unrelated to anger expression. Finally, the TAS-20 predicted greater anger expression. Findings support the validity of the AEI Anger-Out scale but raise questions about the other measures. The assessment of emotional expression by self-report is complex and perhaps confounded by general emotional experience, the specificity or generality of the emotion(s) assessed, and self-awareness limitations. Performance-based or clinician-rated measures of emotion expression are needed.
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Affiliation(s)
| | | | | | - Erik Schuster
- Department of Behavioral Sciences, Rush University Medical Center
| | - Ellen Kinner
- Department of Behavioral Sciences, Rush University Medical Center
| | - John W. Burns
- Department of Behavioral Sciences, Rush University Medical Center
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Burns JW, Gerhart JI, Bruehl S, Post KM, Smith DA, Porter LS, Schuster E, Buvanendran A, Fras AM, Keefe FJ. Anger arousal and behavioral anger regulation in everyday life among people with chronic low back pain: Relationships with spouse responses and negative affect. Health Psychol 2016; 35:29-40. [PMID: 26030307 PMCID: PMC10839786 DOI: 10.1037/hea0000221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the degree to which anger arousal and anger regulation (expression, inhibition) in the daily lives of people with chronic pain were related to spouse support, criticism, and hostility as perceived by patients and as reported by spouses. METHOD Married couples (N = 105, 1 spouse with chronic low back pain) completed electronic daily diaries, with assessments 5 times/day for 14 days. On these diaries, patients completed items on their own anger arousal, anger expression, and inhibition, and on perceived spouse support, criticism, and hostility. Spouses reported on their responses toward patients and their negative affect. Hierarchical linear modeling tested concurrent and lagged relationships. RESULTS Patient-reported increases in anger arousal and anger expression were predominantly related to concurrent decreases in patient-perceived and spouse-reported spouse support, concurrent increases in patient-perceived and spouse-reported spouse criticism and hostility, and increases in spouse-reported negative affect. Relationships for anger expression remained significant with anger arousal controlled. These effects were especially strong for male patients. Spouses reported greater negative affect when patients were present than when they were not. CONCLUSIONS Social support may facilitate adjustment to chronic pain, with declining support and overt criticism and hostility possibly adversely impacting pain and function. Results suggest that patient anger arousal and expression may be related to a negative interpersonal environment for married couples coping with chronic low back pain.
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Affiliation(s)
- John W Burns
- Department of Behavioral Sciences, Rush University Medical Center
| | - James I Gerhart
- Department of Behavioral Sciences, Rush University Medical Center
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center
| | | | | | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Erik Schuster
- Department of Behavioral Sciences, Rush University Medical Center
| | | | - Anne Marie Fras
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Darnall BD. "Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Study Review and Brief Commentary". ACTA ACUST UNITED AC 2015; 3. [PMID: 26985456 DOI: 10.4172/2375-4273.1000142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
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