Patterns of Approach to Activity in 851 Patients With Severe Chronic Pain: Translation and Preliminary Validation of the 9-item Avoidance-Endurance Fast-Screen (AEFS) Into Danish

[Avoidance-endurance fast screen : AEFS validation with one- and two-level response scaling in healthy subjects]

BACKGROUND AND OBJECTIVES

Chronic pain affects an enormous number of patients in Germany. Therefore, early detection is important using easy, quick and reasonable screening methods. The avoidance-endurance fast screen is currently available in two different versions: one asking for pain-related behaviour in light and severe pain and the other assessing overall severe pain-related behaviour. In this study we aim to examine the agreement between both scales and for the first time describe the role of protective psychological features such as resilience and self-compassion in this model.

MATERIALS AND METHODS

Epidemiological cross-sectional study (n = 278) of a healthy cohort occasionally experiencing pain (< 3 months). The analysis was done using standard descriptive statistics, correlations (Spearman's rho) and deductive statistics (t-tests and one-factor ANOVA with post hoc Bonferroni correction) and effect sizes (Cohen's d). Matching of the instruments was calculated with Cohen's kappa.

RESULTS

The results showed a moderate agreement for the two versions. A validity check of the subgroups resulted in comparable findings. The one-level version scored higher in terms of pain persistence which caused subgroup changes from adaptive to eustress-endurance responses and from fear-avoidance to distress-endurance responses. The distress-endurance subgroup had significantly lower values of the trait self-compassion.

CONCLUSIONS

Based on the results of this study, the quality of agreement between the two AEFS versions is considered strong. Without the comparison between mild and strong pain, endurance behaviour was reported more often. According to these findings, overestimation of pain persistence behaviour using the one-level version might result. Therefore, future studies should re-evaluate the cut-offs. As reported in previous studies, protective psychological features showed the highest scores in the eustress-endurance subgroup.

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of the avoidance endurance behavior questionnaire in patients with chronic musculoskeletal pain

BACKGROUND

The Avoidance Endurance Questionnaire (AEQ) successfully measures the fear-avoidance and endurance-related responses to chronic pain.

OBJECTIVE

The objective of this study was to translate, cross-culturally adapt AEQ into Urdu and assess the reliability and validity of the Urdu version.

METHOD

For the translation and cross-cultural adaptation process, the Beaton Guidelines were followed. A total of 103 participants responded to the Urdu version of the AEQ SF-12, Pain Catastrophizing Scale (PCS) and Numeric Pain Rating Scale (NPRS) at baseline and after 48 hours. The test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Cronbach's alpha was used to measure internal consistency. To measure validity, Pearson's correlation between the subscales of AEQ-Urdu and other outcome measures (SF-12, PCS and NPRS scores) were used (p< 0.05).

RESULTS

The mean age of the total 103 participants was 32.7 ± 10.90 among which 45 (43.6%) were male and 58 (56.3%) were female. The pre-final version of the translated AEQ was tested on 40 Urdu speaking participants and no major changes were made. The Cronbach's alpha for all subscales of the AEQ-Urdu ranged from 0.848-0.990. AEQ-U showed an excellent test-retest reliability with the ICC ranging from 0.775-0.996. The majority of the subscales of AEQ showed significant (p< 0.05) positive correlation with pain scales (PCS and NPRS) and negative correlation with the domains of SF-12.

CONCLUSION

The AEQ-U has reliable and valid construct validity, good internal consistency, and test-retest reliability, indicating that it has adequate psychometric features and can be a useful tool for evaluating pain responses in patients with chronic musculoskeletal pain.

Perceived psychosocial stressors and coping resources in chronic low back pain patients as classified by the avoidance-endurance model

Objectives

The Avoidance-Endurance Model distinguishes between subgroups of low back pain (LBP) patients with three maladaptive styles of coping with pain: fear-avoidance (FAR), distress-endurance (DER), eustress-endurance (EER), and one adaptive coping style (AR). This study aimed to compare the quantity of patients' perceived psychosocial stressors and coping resources across these subgroups.

Materials and methods

This cross-sectional study was conducted at an outpatient rehabilitation center for patients with chronic musculoskeletal pain. One hundred and thirty-seven patients (69 women/68 men) with chronic LBP were assessed using the following: a demographic checklist, the visual analogue scale, Avoidance-Endurance Questionnaire, Roland-Morris Disability Questionnaire, Pain Disability Index, and 36-Item Short Form. Subsequently, patients participated in semi-structured interviews led by clinical psychologists, which were intended to identify their perception of stressors and coping resources. The quantity of psychosocial stressors and coping resources were analyzed using deductive and inductive content analyses and then compared between subgroups using chi-square-tests.

Results

FARs experienced significantly higher levels of “mental suffering” (p = &lt;0.001) and “other workplace problems” compared to ARs and EERs (p = &lt;0.001). DERs reported significantly higher levels of “mental suffering” (p = &lt;0.001), “job stress” (p = 0.022), and “familial losses” (p = 0.029) compared to ARs, whereas the AR group demonstrated significantly more “coping resources” (p = 0.001) compared to FARs.

Conclusion

AEM-subgroups differed in the quantity of perceived psychosocial stressors and coping resources with AR, who demonstrated a lower risk for pain chronicity and reported the highest quantity of resources. The variability across subgroups may imply differences in patientś needs regarding therapeutic interventions and suggests that a resource-centered approach to cope with stress and pain may be beneficial.

Socio-Demographics, Pain Characteristics, Quality of Life and Treatment Values Before and After Specialized Interdisciplinary Pain Treatment: Results from the Danish Clinical Pain Registry (PainData)

BACKGROUND AND AIMS

PainData is an electronic internet-based clinical pain registry established to improve the understanding and treatment of high-impact chronic pain. The primary aim of this paper is to describe socio-demographics, pain characteristics, quality of life, and treatment values at baseline and follow-up in individuals referred to public and private interdisciplinary pain centers in Denmark between 2018 and 2020.

METHODS

Self-reported patient-reported outcomes collected through PainData before (n=12,257) and after (n=4,111) treatment across 13 public and private interdisciplinary specialized pain centers in Denmark (87% of all pain centers in Denmark) are described.

RESULTS

Mean duration of pain was 10 years, and one in three patients reported chronic widespread pain. More than 40% reported opioid use, and 50% had tried four or more different treatment modalities prior to referral. More than 60% reported poor sleep, severe fatigue, and memory and/or concentration deficits. Mean scores on pain catastrophizing, fear of movement, and pain-related disability were high, whereas scores on pain acceptance and self-efficacy were low. Physical and mental health were rated as poor and fair, respectively. One in four patients reported being very much improved or much improved after treatment. Items commonly reported after treatment were increased knowledge about pain, emotions and mood (66.5%), being better at accepting life with chronic pain (63.1%), and improved activity pacing (60.6%).

CONCLUSION

The PainData registry, containing data from a large cohort of individuals, can help to improve the understanding and treatment of high-impact chronic pain, and collaborations with other researchers are welcome.

Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes

OBJECTIVES

Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up.

METHODS

We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0-10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207 days (SD=154).

RESULTS

At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i) pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances.

CONCLUSIONS

Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.