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Kästner A, Petzke F. Personality systems interactions theory: an integrative framework complementing the study of the motivational and volitional dynamics underlying adjustment to chronic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1288758. [PMID: 38634004 PMCID: PMC11021701 DOI: 10.3389/fpain.2024.1288758] [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: 09/04/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
In the endeavor to advance our understanding of interindividual differences in dealing with chronic pain, numerous motivational theories have been invoked in the past decade. As they focus on relevant, yet different aspects of the dynamic, multilevel processes involved in human voluntary action control, research findings seem fragmented and inconsistent. Here we present Personality Systems Interactions theory as an integrative meta-framework elucidating how different motivational and volitional processes work in concert under varying contextual conditions. PSI theory explains experience and behavior by the relative activation of four cognitive systems that take over different psychological functions during goal pursuit. In this way, it may complement existing content-related explanations of clinical phenomena by introducing a functional, third-person perspective on flexible goal management, pain acceptance and goal maintenance despite pain. In line with emerging evidence on the central role of emotion regulation in chronic pain, PSI theory delineates how the self-regulation of positive and negative affect impacts whether behavior is determined by rigid stimulus-response associations (i.e., habits) or by more abstract motives and values which afford more behavioral flexibility. Along with testable hypotheses, multimodal interventions expected to address intuitive emotion regulation as a central process mediating successful adaptation to chronic pain are discussed.
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Affiliation(s)
- Anne Kästner
- Department of Anesthesiology, Pain Clinic, University Hospital, Georg-August-University of Goettingen, Goettingen, Germany
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Alshahrani MS, Reddy RS. Kinesiophobia, limits of stability, and functional balance assessment in geriatric patients with chronic low back pain and osteoporosis: a comprehensive study. Front Neurol 2024; 15:1354444. [PMID: 38414551 PMCID: PMC10897043 DOI: 10.3389/fneur.2024.1354444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Background The significance of studying Kinesiophobia, Limits of Stability (LOS), and functional balance in geriatric patients with CLBP and osteoporosis lies in their profound impact on rehabilitation outcomes and fall risk, ultimately affecting patients' quality of life. This study aimed to examine LOS and functional balance in the geriatric population concurrently experiencing Chronic Low Back Pain (CLBP) and osteoporosis, in comparison to age-matched healthy controls; to assess the correlations between Kinesiophobia, LOS, and functional balance assessments; and to evaluate the mediating influence of Kinesiophobia on the association between LOS and functional balance tests. Methods This cross-sectional study included a total of 86 participants in each group. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). LOS variables were evaluated with a computerized Iso-free platform in eight different directions. Functional balance was measured using the Timed Up and Go (TUG) test and the Berg Balance Scale (BBS). Results Patients with CLBP and osteoporosis showed significantly lower LOS percentages (45.78 ± 6.92) and impaired Functional Balance, reflected in a TUG Score (10.45 ± 2.23), compared to asymptomatic controls (LOS: 76.95 ± 8.21; TUG: 8.73 ± 1.90). Kinesiophobia showed a significant moderate negative correlation with LOS, indicated by r = -0.362 (p < 0.01). Additionally, Kinesiophobia was found to correlate with functional balance tests. Specifically, there was a moderate positive correlation with the TUG Score (r = 0.322, p < 0.01), indicating that higher Kinesiophobia is associated with slower TUG performance. Conversely, a stronger moderate negative correlation was observed with the Berg Balance Scale (BBS) Score (r = -0.436, p < 0.001), suggesting that increased Kinesiophobia is associated with lower BBS scores, indicating poorer balance performance. Mediation analysis revealed that Kinesiophobia significantly influences LOS and Functional Balance. For LOS and the TUG score, Kinesiophobia showed a direct effect (B = 0.24), an indirect effect (B = 0.09), and a total effect (B = 0.13). Similarly, for LOS and the BBS score, the direct effect of Kinesiophobia was B = 0.38, with an indirect effect of B = 0.10 and a total effect of B = 0.20. Conclusion This study underscores the substantial impact of Kinesiophobia on both stability and functional balance in individuals coping with CLBP and osteoporosis. The findings emphasize the clinical relevance of addressing Kinesiophobia as a potential target for interventions aimed at improving LOS and functional balance in this specific patient population.
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Affiliation(s)
| | - Ravi Shankar Reddy
- Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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Amabile AH, Larson SL, Hoglund LT, Guarnieri JP, McDonald M, Reich MR. Greater number of weekly stairs climbed is associated with lower low back pain prevalence among female but not male physical therapists. PLoS One 2023; 18:e0292489. [PMID: 37797076 PMCID: PMC10553291 DOI: 10.1371/journal.pone.0292489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Certain cardiovascular health benefits of stair climbing are now widely accepted, but no prior studies have as yet been found linking the quantity of stairs climbed to low back pain (LBP) morbidity. Low back pain is a common musculoskeletal impairment, and research has begun to show an association between LBP and gluteus maximus (GM) weakness. With stair climbing being the activity which most activates GM, the aim of the present research was to assess the relationship between stair ambulation and LBP prevalence. The hypothesis of this cross-sectional study was that individuals with LBP would report a significantly lower numbers of stair flights climbed compared with individuals without LBP. METHODS A survey tool was developed and distributed via email to a convenience sample of orthopedic physical therapists. Survey items included information regarding medical history, physical activity, workplace, and LBP factors, using a one-year prevalence period. RESULTS A total of 363 respondents took the survey and, after application of exclusion criteria, 248 records remained in our final sample. When analyzing all genders together, non LBP (NLBP) respondents reported a mean of 51.62 flights climbed per week; and LBP respondents reported 37.82 flights climbed per week, with P = 0.077. When males and females were analyzed separately, a statistically significant difference in mean number of flights of stairs climbed was found among female respondents (61.51 flights climbed for NLBP and 35.61 flights climbed for LBP females; P = 0.031). When analyzed based on chronicity of LBP, an even stronger association between stairs climbed and LBP prevalence was found for female respondents with acute LBP (P = 0.009). CONCLUSIONS More weekly stairs climbed was associated with a lower LBP prevalence among females, especially with respect to acute LBP. Randomized, longitudinal research is, however, required to confirm a relationship between stair climbing and LBP.
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Affiliation(s)
- Amy H. Amabile
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, MERB 457, Philadelphia, PA, United States of America
| | - Sharon L. Larson
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Lisa T. Hoglund
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - John P. Guarnieri
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Maureen McDonald
- Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Madeline R. Reich
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
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Diotaiuti P, Corrado S, Mancone S, Cavicchiolo E, Chirico A, Siqueira TC, Andrade A. A psychometric evaluation of the Italian short version of the Fear of Pain Questionnaire-III: Psychometric properties, measurement invariance across gender, convergent, and discriminant validity. Front Psychol 2023; 13:1087055. [PMID: 36726497 PMCID: PMC9886064 DOI: 10.3389/fpsyg.2022.1087055] [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: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The Fear of Pain Questionnaire-III (FPQ-III) is a self-assessment instrument developed specifically to measure fear based on various pain stimuli converging on three factors: severe pain, medical pain, and minor pain. It actually remains the most studied and internationally used tool even in its short versions. The aim of this work was to propose a new validation study oriented to confirm the good psychometric properties of a short model of the FPQ-III for the Italian context. Methods A large sample of participants was recruited (n = 1,064) and Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were performed. Measurement invariance of the FPQ-III across gender was also evaluated. In order to examine convergent validity, a further convenient sample (n = 292) was used and variables related to the individual's pain experience, locus of control and coping orientations were assessed. A final discriminant assessment using experimental manipulation through fear eliciting videos was performed. Results The three factors structure of the 13-item version of the questionnaire was confirmed (χ2 = 148.092, CFI = 0.971, TLI = 0.962, RMSEA = 0.046, RMSEA 90% CI = 0.037-0.056) as well as the measurement invariance across gender. Item internal reliability was satisfactory. The results provided evidence of the good predictive validity of the FPQ-III and the discriminant assessment demonstrated that the instrument is suitable in detecting changes in fear of pain induced by specific situational conditions. Discussion The scale in this short version is suitable for quickly and efficiently gathering information about the perceived intensity of such anticipatory fears that might affect even the healthy person dysfunctionally.
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Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Lazio, Cassino, Italy,*Correspondence: Pierluigi Diotaiuti,
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Lazio, Cassino, Italy
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Lazio, Cassino, Italy
| | - Elisa Cavicchiolo
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Chirico
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Rome, Italy
| | - Thais Cristina Siqueira
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Alexandro Andrade
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
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Fehrmann E, Fischer-Grote L, Kienbacher T, Tuechler K, Mair P, Ebenbichler G. Perceived psychosocial stressors and coping resources in chronic low back pain patients as classified by the avoidance-endurance model. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:996945. [DOI: 10.3389/fresc.2022.996945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
ObjectivesThe 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 methodsThis 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.ResultsFARs experienced significantly higher levels of “mental suffering” (p = <0.001) and “other workplace problems” compared to ARs and EERs (p = <0.001). DERs reported significantly higher levels of “mental suffering” (p = <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.ConclusionAEM-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.
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Strigo IA, Keltner JR, Ellis RJ, Simmons AN. Association of painful human immunodeficiency virus distal sensory polyneuropathy with aberrant expectation of pain relief: functional magnetic resonance imaging evidence. Brain Commun 2021; 3:fcab260. [PMID: 34859214 PMCID: PMC8633742 DOI: 10.1093/braincomms/fcab260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/14/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022] Open
Abstract
Mechanisms underlying chronic neuropathic pain associated with HIV-associated distal sensory polyneuropathy are poorly understood, yet 40% of those with distal neuropathy (or 20% of all people with HIV) suffer from this debilitating condition. Central pain processing mechanisms are thought to contribute to the development of HIV neuropathic pain, yet studies investigating central mechanisms for HIV neuropathic pain are few. Considering the motivational nature of pain, we aimed to examine the degree to which expectation of pain onset and expectation of pain offset are altered in sixty-one male patients with HIV-related distal sensory polyneuropathy with (N = 30) and without (N = 31) chronic neuropathic pain. By contrasting painful (foot) and non-painful (hand) sites between those with and without neuropathic pain, we could identify unique neural structures that showed altered activation during expectation of pain offset or relief. Our results showed no evidence for peripheral mechanisms evidenced by lack of significant between group differences in thermo-sensation, subjective pain response or epidermal nerve fibre density. Likewise, we found no significant differences between groups in subjective or brain mechanisms underlying the expectation of pain onset. Conversely, we found significant interaction within right anterior insula during expectation of pain offset in our study in that individuals in the pain group compared to the no-pain group exhibited increased anterior insula activation on the painful compared to the non-painful site. Our findings are consistent with abnormal processing of expectation of pain offset or abnormal pain relief-related mechanisms potentially due to increased emotional distress regarding the experience of chronic endogenous pain.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory Research, San Francisco Veterans Affairs Health Care Center, San Francisco, CA 94121, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
| | - John R Keltner
- Stress and Neuroimaging Laboratory Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92151, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Ronald J Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Alan N Simmons
- Stress and Neuroimaging Laboratory Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92151, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.,Center of Excellence in Stress and Mental Health Research, San Diego Veterans Affairs Health Care Center, San Diego, CA 92161, USA
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[Results of a pilot study on the role of therapy expectation in interdisciplinary multimodal pain therapy for chronic back pain]. Schmerz 2021; 36:172-181. [PMID: 34618234 PMCID: PMC9156493 DOI: 10.1007/s00482-021-00590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Hintergrund Chronische Rückenschmerzen sind eine schwerwiegende und global sehr häufig auftretende Erkrankung mit enormen persönlichen sowie sozioökonomischen Auswirkungen. Die interdisziplinäre multimodale Schmerztherapie (IMST) ist eines der wenigen evidenzbasierten Behandlungsverfahren für chronische Schmerzen. Obwohl bekannt ist, dass Schmerzen sowie deren Chronifizierung und Behandlung von den persönlichen Erwartungen der Patienten beeinflusst werden, gibt es wenige etablierte Interventionen oder Richtlinien für eine aktive Modulation dieses Effekts. Ziel der Arbeit Wir möchten mit dieser Arbeit die Rolle der Erwartung als Prädiktor für Schmerzen sowie schmerzbezogene Beeinträchtigung in der klinischen Praxis verdeutlichen und präsentieren hierzu beispielhaft explorative Pilotdaten einer Beobachtungskohorte unserer Klinik. Material und Methoden Die Untersuchung zeigt erste Daten einer prospektiven longitudinalen Beobachtungsstudie bestehend aus bis zu 41 Patienten mit chronischen Rückenschmerzen, die im Setting einer IMST am Essener Rückenschmerz-Zentrum behandelt wurden. Es wurden Daten zum Zeitpunkt der Aufnahme (T0) und der Entlassung (T1) sowie drei Monate nach Therapieende (T2) erhoben. Primäre Endpunkte waren die Schmerzintensität und die Schmerzbeeinträchtigung. Zusätzlich erfassten wir die Therapieerwartung zum Zeitpunkt der Aufnahme als möglichen Prädiktor. Die Bedeutung der vor der Therapie erhobenen Therapieerwartung wurde mittels linearer Regression erfasst. Ergebnisse Die IMST führte zu einer signifikanten Besserung in Bezug auf die Schmerzintensität und -beeinträchtigung. Der Effekt auf die Schmerzintensität war über den Zeitraum von drei Monaten nach Therapieende anhaltend und die Beeinträchtigung sank in diesem Zeitraum weiter signifikant. Diskussion Erwartung war ein signifikanter Prädiktor für die Abnahme der Schmerzintensität und erklärte ca. 15 % der Varianz. In der klinischen Praxis sollten daher valide Methoden etabliert werden, negative Erwartungen zu reduzieren und positive Erwartungen zu fördern.
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Filipczyk P, Filipczyk K, Saulicz E. Influence of Stabilization Techniques Used in the Treatment of Low Back Pain on the Level of Kinesiophobia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126393. [PMID: 34199155 PMCID: PMC8296215 DOI: 10.3390/ijerph18126393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/01/2023]
Abstract
The aim of this study was to try to compare the effectiveness of manual therapy techniques in combination with stabilization techniques: the so-called Australian method and the Neurac method in relation to pain sensations and the level of kinesiophobia. A total of 69 people were examined, divided into three groups of 23 people each. The Visual Analogue Scale was used to assess the antalgic effect, and the Kinesiophobia Causes Scale questionnaire was used to assess the level of kinesiophobia. Patients improved over four weeks, during which they were assessed three times. The evaluation of the desired parameters was also performed over a 24-week period to assess long-term performance. Stabilization techniques are an effective extension of manual therapy techniques in patients with low back pain. People in the groups additionally improved in terms of stabilization techniques, which are characterized by a lower level of kinesiophobia. Its lowest level was found in the group additionally improved with the Neurac method. In the long-term study, the level of kinesiophobia in this group was still maintained at a reduced level. The use of stabilization techniques involving patients in action may significantly affect the level of kinesiophobia, and thus have a much wider effect than just pain reduction.
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Affiliation(s)
- Przemysław Filipczyk
- Faculty of Health Sciences, Jan Długosz University in Czestochowa, 42-200 Czestochowa, Poland
- Correspondence: ; Tel.: +48-34-365-59-83
| | - Karolina Filipczyk
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 42-612 Katowice, Poland;
| | - Edward Saulicz
- Departhment of Kinesiotheraphy and Special Methods in Physiotheraphy, The Physical Education Academy Jerzy Kukuczka in Katowice, 40-065 Katowice, Poland;
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