Differences in adaptive and maladaptive psychosocial responses to chronic pain among adults with varying physical activity levels

Exploring mechanisms of improvement in the Active Brains intervention for older adults with chronic pain and early cognitive decline

OBJECTIVES

We iteratively developed, optimized, and established the feasibility of a virtual, group-based, mind-body activity program (Active Brains, AB), supported by Fitbit for older adults with chronic pain (CP) and early cognitive decline (ECD). Guided by the principles of the NIH stage model we 1) explore signals of improvement in AB outcomes and hypothesized mechanisms of action and 2) explore relationships between changes in outcomes with changes in mechanisms.

METHODS

Participants were N = 15 older adults (age ≥ 60) with CP-ECD from two NIH stage 1 pilot studies of AB. We conducted paired t-tests to explore pre-post improvements, and correlations to investigate associations between changes in outcomes and mechanisms.

RESULTS

We observed small to large improvements across co-primary and secondary outcomes (d = 0.24-1.09). We observed small to medium improvements in 4 out of 5 hypothesized mechanisms (d = 0.23-0.47). Overall, improvements in outcomes had moderate to large associations with improvements in hypothesized mechanisms.

CONCLUSION

AB was associated with improvements across several co-primary and secondary outcomes, and hypothesized mechanisms. Pain-specific coping and general coping skills are promising treatment targets to address the CP-ECD comorbidity among older adults.

The Role of Awareness of Age-Related Change in the Longitudinal Association between Pain and Physical Activity

We examined how physical pain impacts the developmental construct of Awareness of Age-Related Change (AARC-gains and AARC-losses) and, in turn, how AARC mediates and moderates the association between pain and subsequent physical activity. We used longitudinal data from 434 participants of the UK PROTECT Study (mean age = 65.5 years; SD = 6.94 years). We found that pain in 2019 predicted higher AARC-losses (β = .07; p = .036) and less physical activity (β = -.13; p-value = .001) in 2020. Additionally, we found that AARC-losses partially mediated, but did not moderate, the association of pain in 2019 and physical activity in 2020. AARC-losses may explain physical inactivity in middle-aged and older adults experiencing pain. Incorporating developmental constructs such as AARC into theories and empirical studies on pain and pain management may be necessary to more fully capture people's responses to pain.

Differences in Resilience Mechanisms and Physical Activity among Women Experiencing Chronic Pain with Higher or Lower Resilience

BACKGROUND

Chronic pain is a public health issue, with women being disproportionately impacted. Progressing from light physical activity to the recommended moderate to vigorous intensities is effective for chronic pain self-management, yet participation is low among women experiencing chronic pain. Researchers studying resilience approaches to chronic pain contend that women with higher resilience, or functioning well despite adverse life stressors including chronic pain, should have better resilience mechanisms and more physical activity participation. The purpose of this work was to examine whether women experiencing chronic pain, reporting higher versus lower resilience, differed in resilience mechanisms (pain acceptance, self-regulatory efficacy to overcome pain and related barriers to activity, and self-regulatory efficacy to schedule and plan activity) and physical activity (light, moderate-vigorous).

METHODS

Adult women experiencing chronic pain (N = 269; M_age = 38.35, SD = 13.13 years) completed an online survey assessing study variables.

RESULTS

A multivariate analysis of covariance comparing participants with higher (n = 131) and lower (n = 138) resilience, controlling for age and pain intensity, was significant (p < .001; η²_partial = .17). Participants with higher resilience reported significantly higher pain acceptance, self-regulatory efficacy beliefs, and moderate-vigorous physical activity (p's < .01; η²_partial = .03 to .14, small to large effects). Light activity did not differ.

CONCLUSIONS

Novel findings illustrated that participants with higher resilience exhibited more favorable resilience mechanisms and participation in the recommended moderate-vigorous activity. If intervening among women with lower resilience to improve their resilience mechanisms and moderate-vigorous activity is effective, then intervention adoption and delivery across communities could promote improved pain self-management among women.