The Coping Strategies Questionnaire – Swedish Version: Evidence of Reliability and Validity in Patients with Fibromyalgia

The Coping Strategies Questionnaire: Translation, cultural adaptation, reliability and validity in Turkish-speaking patients with chronic musculoskeletal pain

BACKGROUND

The use of pain coping questionnaires is advantageous when selecting cognitive and behavioral targets for chronic pain management. The objective of this study was to investigate adaptation, validity, and reliability of the Coping Strategies Questionnaire (CSQ) in Turkish population with chronic musculoskeletal pain.

METHODS

The Turkish version of the questionnaire (CSQ-T) was checked in terms of reliability and validity with a convenience sample of 123 patients with chronic musculoskeletal pain. Reliability (test-retest) analyses were conducted by means of a retest 48 hours later with a sub-group of 40 patients. Construct validity of the CSQ was checked through convergent validity with the Hospital Anxiety and Depression Scale (HADS) and the Short Form-36 (SF-36) health survey.

RESULTS

Cronbach's alpha of the subscales ranged from 0.814 to 0.934 and the test-retest reliability ranged from 0.800 to 0.944. Neither floor nor ceiling effects (15%) were found in the subscales (13.8%) and the total score (4.1%) of the CSQ-T. Factor analysis indicated that the scale had two factors. The total CSQ-T score was correlated with both the HADS (r: -0.636/-0.549) and the SF-36 (r: 0.701/0.768).

CONCLUSION

The CSQ-T is a reliable and valid measure for assessing patients with chronic musculoskeletal pain.

Patients' health outcomes after an implementation intervention targeting the physiotherapists' clinical behaviour

Background

A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach.

Methods

An explorative and comparative pre−/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used.

Results

There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support.

Conclusion

It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients’ outcomes in this study. Most of the patients’ health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach.

Trial registration

The study protocol was retrospectively registered in ClinicalTrials.gov. ID NCT03118453, March 20, 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40945-021-00116-z.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Confirmatory Factor Analysis, Reliability, and Validity of the Persian Version of the Coping Strategies Questionnaire for Iranian People With Nonspecific Chronic Neck Pain

OBJECTIVE

The purpose of this study was to assess the reliability and construct validity of, and perform confirmatory factor analysis of, the Persian version of the Coping Strategies Questionnaire (CSQ) for Iranian people with nonspecific chronic neck pain.

METHODS

We performed psychometric testing of the Persian version of the Coping Strategies Questionnaire. Participants were 123 native Persian speakers with chronic neck pain lasting at least 3 months. They were between 18 and 55 years old. The CSQ was administered by self-report. After 5 to 7 days, 94 participants completed the questionnaire in the retest session. Confirmatory factor analysis was done to assess the model fit (χ² test, comparative fit index, and root-mean-square error of approximation) of the 7-factor solution of the Persian version of the CSQ. The Cronbach α was used for internal consistency; intraclass correlation coefficient, standard error of measurement, and minimal detectable change for reliability; and nonparametric tests of group differences and correlations for construct validity. To assess the construct validity, we examined the ability of the CSQ to discriminate people based on sex, level of education, and physical activity. Correlations with the Short Form Health Survey (SF-12), Tampa Scale for Kinesiophobia, visual analog scale, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, and Neck Disability Index were also determined to test the validity.

RESULTS

Confirmatory factor analysis measures-χ² test, comparative fit index, and root-mean-square error of approximation-were 1.72, 0.76, and 0.07, respectively. Internal consistency was excellent (0.85). All intraclass correlation coefficients were above the acceptable level of 0.70, with the highest reliability obtained for the Praying subscale in both test and retest sessions. The standard error of measurement for the CSQ total score was 2.26, and the minimal detectable change was 6.25. The Cronbach α for the total score and for the subscales ranged from 0.75 to 0.93. Scores of the subscales of the CSQ and other questionnaires showed low correlation except for the physical component of the SF-12. The Catastrophizing subscale had a positive correlation with the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, and Neck Disability Index, and a negative correlation with the SF-12.

CONCLUSION

The CSQ has acceptable and good measurement properties to assess coping strategies in Iranian people with nonspecific chronic neck pain. It is a reliable measure, though, for validity only The Catastrophizing subscale showed significant correlation with other scales, but the findings should be interpreted with caution because of the limitations of the study.

Mindfulness is associated with psychological health and moderates the impact of fibromyalgia

OBJECTIVE

Previous studies suggest mindfulness is associated with pain and depression. However, its impact in individuals with fibromyalgia remains unclear. We examined associations between mindfulness and physical and psychological symptoms, pain interference, and quality of life in fibromyalgia patients.

METHODS

We performed a cross-sectional analysis on baseline data from a fibromyalgia clinical trial. Mindfulness was assessed using the Five Facet Mindfulness Questionnaire (FFMQ). Pearson's correlations and multivariable linear regression models were used to evaluate associations between mindfulness and fibromyalgia impact, pain interference, physical function, depression, anxiety, stress, self-efficacy, and health-related quality of life. We also examined whether mindfulness moderated associations between fibromyalgia impact and psychological outcomes.

RESULTS

A total of 177 participants (age 52.0 ± 12.2 (SD) years; 93.2% women; 58.8% white; body mass index 30.1 ± 6.7 kg/m²; FFMQ score 131.3 ± 20.7; Revised Fibromyalgia Impact Questionnaire score 57.0 ± 19.4) were included. Higher total mindfulness was significantly associated with lower fibromyalgia impact (r = - 0.25), pain interference (r = - 0.31), stress (r = - 0.56), anxiety (r = - 0.58), depression (r = - 0.54), and better mental health-related quality of life (r = 0.57). Describing, Acting-with-awareness, and Non-judging facets of mindfulness were also associated with these outcomes. Mindfulness moderated the effect of fibromyalgia impact on anxiety (interaction P = 0.01).

CONCLUSION

Higher mindfulness is associated with less pain interference, lower impact of fibromyalgia, and better psychological health and quality of life in people with fibromyalgia. Mindfulness moderates the influence of fibromyalgia impact on anxiety, suggesting mindfulness may alter how patients cope with fibromyalgia. Future studies should assess how mind-body therapies aiming to cultivate mindfulness may impact the well-being of patients with fibromyalgia.

KEY POINTS

• Higher mindfulness was associated with better psychological health and lower overall impact of fibromyalgia. • Mindfulness moderated the relationship between overall fibromyalgia impact and anxiety.

Assessing psychological factors, social aspects and psychiatric co-morbidity associated with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men -- a systematic review

OBJECTIVE

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain disease with high prevalence rates and substantial health care costs. An interdisciplinary classification system is commonly used (UPOINT) which includes psychosocial factors. Nevertheless, psychosocial influences on CP/CPPS only recently became a research focus. Therefore, we aimed to synthesize the existing data and to identify further research topics. Then, based on our results, diagnosis and treatment can be improved.

METHODS

In a systematic review conducted according to the PRISMA reporting guidelines we searched different databases (MEDLINE, EMBASE, PsychINFO) using the broad search terms "chronic pelvic pain syndrome AND men". Two raters independently screened the literature and assessed the risk of bias.

RESULTS

We included 69 original research articles which considered psychosocial variables. We found studies investigating different psychosocial factors (pain catastrophizing, stress, personality factors, social aspects), co-morbid psychiatric disorders (depression, anxiety and trauma-related disorders, somatization disorder, substance abuse) and Quality of Life (QoL). In addition, there is a high risk of bias in most studies e.g. concerning the study design or the measures.

CONCLUSIONS

There is evidence suggesting that psychological factors are important in understanding CP/CPPS. However, research concentrated on a few aspects while the others were not covered adequately. We found evidence of a higher number of psychosocial factors and psychiatric co-morbidities than is currently included in the UPOINT system. More high quality research is needed to understand the interplay of psychosocial factors in CP/CPPS. Furthermore, these factors should be incorporated into treatment approaches.

Segregating the cerebral mechanisms of antidepressants and placebo in fibromyalgia

Antidepressant drugs are commonly used to treat fibromyalgia, but there is little knowledge about their mechanisms of action. The aim of this study was to compare the cerebral and behavioral response to positive treatment effects of antidepressants or placebo. Ninety-two fibromyalgia patients participated in a 12-week, double-blind, placebo-controlled clinical trial with milnacipran, a serotonin-norepinephrine reuptake inhibitor. Before and after treatment, measures of cerebral pain processing were obtained using functional magnetic resonance imaging. Also, there were stimulus response assessments of pressure pain, measures of weekly pain, and fibromyalgia impact. Following treatment, milnacipran responders exhibited significantly higher activity in the posterior cingulum compared with placebo responders. The mere exposure to milnacipran did not explain our findings because milnacipran responders exhibited increased activity also in comparison to milnacipran nonresponders. Stimulus response assessments revealed specific antihyperalgesic effects in milnacipran responders, which was also correlated with reduced clinical pain and with increased activation of the posterior cingulum. A short history of pain predicted positive treatment response to milnacipran. We report segregated neural mechanisms for positive responses to treatment with milnacipran and placebo, reflected in the posterior cingulum. The increase of pain-evoked activation in the posterior cingulum may reflect a normalization of altered default mode network processing, an alteration implicated in fibromyalgia pathophysiology.

PERSPECTIVE

This study presents neural and psychophysical correlates to positive treatment responses in patients with fibromyalgia, treated with either milnacipran or placebo. The comparison between placebo responders and milnacipran responders may shed light on the specific mechanisms involved in antidepressant treatment of chronic pain.

Body mass index and response to a multidisciplinary treatment of fibromyalgia

The purpose of this study is to determine whether there are some differences in the treatment responses to a multidisciplinary fibromyalgia (FM) treatment related with the baseline body mass index (BMI) of the participants. Inclusion criteria consisted of female sex, a diagnosis of FM (American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Baseline BMI was determined, and patients were randomly assigned to one of the two treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were pain intensity, functionality, catastrophizing, psychological distress, health-related quality of life, and sleep disturbances. One hundred thirty patients participated in the study. No statistical significant differences regarding pre-treatment outcomes were found among the different BMI subgroups, and between the two experimental conditions for each BMI category. General linear model analysis showed a significant interaction group treatment × time in pain intensity (p < .01), functionality (p < .0001), catastrophizing (p < .01), psychological distress (p < .0001), sleep index problems (p < .0001), and health-related quality of life (p < .05). No significant interactions were found in BMI × time, and in BMI × group treatment × time. There are not differences among normal weight, overweight and obese patients with FM regarding their response to a multidisciplinary treatment programme for FM which combines pharmacological treatment, education, physical therapy and cognitive behavioural therapy.

The chronic prostatitis/chronic pelvic pain syndrome and pain catastrophizing: a vicious combination

OBJECTIVE

This study aimed to evaluate the presence and importance of pain catastrophizing among men diagnosed with chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) in a routine clinical setting.

MATERIAL AND METHODS

61 men, mean age 46 ± 11 years, with a mean CP/CPPS history of 11 ± 11 years, completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Short-Form McGill Pain Questionnaire (SF-MPQ) and Coping Strategies Questionnaire (CSQ) to evaluate pain catastrophizing, and the International Index of Erectile Function (IIEF-5). They were also scored according to the UPOINT system.

RESULTS

The patients' mean scores were: IEEF-5 17.6 ± 7.3, NIH-CPSI pain subscale 11.1 ± 4.4, quality of life question 2.7 ± 1.6, quality of life impact subscale 6.9 ± 2.7 and CSQ catastrophizing score 15.3 ± 9.1. Patients with a high tendency for catastrophizing (CSQ score ≥20) (28%) had higher UPOINT and pain scores, worse quality of life and quality of life impact, but did not stand out regarding voiding dysfunction and ejaculatory pain.

CONCLUSIONS

Two distinctly different cohorts could be identified: a smaller cohort with a high degree of catastrophizing, severe pain and poor quality of life, and a larger one with a low degree of catastrophizing, less severe pain and moderately reduced quality of life. It is important in clinical practice to distinguish between the two groups since they require different therapeutic approaches.

Multicomponent cognitive-behavioral group therapy with hypnosis for the treatment of fibromyalgia: long-term outcome

This study compared the efficacy of 2 psychological treatments for fibromyalgia with each other and with standard care. Ninety-three patients with fibromyalgia (FM) were randomly assigned to 1 of the 3 experimental conditions: 1) multicomponent cognitive-behavioral therapy (CBT); 2) multicomponent CBT with hypnosis; and 3) pharmacological treatment (standard care control group). The outcome measures of pain intensity, catastrophizing, psychological distress, functionality, and sleep disturbances were assessed before treatment, immediately after treatment, and at 3- and 6-month follow-up visits. CBT and CBT with hypnosis participants received the standard pharmacological management plus 14 weekly, 120-minute-long sessions of psychological treatment. All but 1 session followed a group format; the remaining session was individual. The analyses indicated that: 1) patients with FM who received multicomponent CBT alone or multicomponent CBT with hypnosis showed greater improvements than patients who received only standard care; and 2) adding hypnosis enhanced the effectiveness of multicomponent CBT. This study presents new evidence about the efficacy of multicomponent CBT for FM and about the additional effects of hypnosis as a complement to CBT. The relevance and implications of the obtained results are discussed.

PERSPECTIVE

This article highlights the beneficial effects of adding hypnosis in a multicomponent cognitive-behavioral group treatment of fibromyalgia patients. Also, this research showed that by adding hypnosis the length of treatment did not increase.

Evaluation of a modification of the UPOINT clinical phenotype system for the chronic pelvic pain syndrome

OBJECTIVE

. To evaluate the recently presented six-domain UPOINT phenotype system for the chronic abacterial prostatitis/chronic pelvic pain syndrome (CPPS) and to correlate it with clinically relevant parameters such as ejaculatory pain, pain localization, erectile dysfunction, cold sensitivity and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).

MATERIAL AND METHODS

Fifty men with CPPS were classified in each of the six UPOINT domains. A CPPS focused history was obtained and the men were asked to complete the NIH-CPSI, the International Index of Erectile Function (IIEF-5) and the Coping Strategies Questionnaire (CSQ).

RESULTS

The mean age was 46 years (range 26-71 years). The percentage positive for each domain was 26 (52%) for urinary, 18 (36%) for psychosocial, 19 (38%) for organ specific, 19 (38%) for infection, 18 (36%) for neurological/systemic and 16 (32%) for pelvic muscle tenderness. Mean NIH-CPSI was 23+/-7. The number of positive domains and the NIH-CPSI [correlation coefficient (r) = 0.478, p=0.002] and its quality of life section (r=0.432, p=0.003) were linked; there was, however, no correlation between the number of positive domains and IIEF-5, ejaculatory pain, painful micturition, cold sensitivity or pain localization (except for scrotal pain). The link between catastrophizing and NIH-CPSI was marked (r=0.61, p<0.001).

CONCLUSIONS

The correlation between the UPOINT score and NIH-CPSI was verified. A weak or lacking correlation with the studied clinical parameters suggests that further development is required before UPOINT can be considered an optimal phenotyping instrument.