A test of the fear avoidance model to predict chronic pain outcomes in a polytrauma sample

COVID-19 impact on post-traumatic stress symptoms in burning mouth syndrome: A multicentric study

OBJECTIVES

This study investigates the psychological impact of COVID-19 on burning mouth syndrome (BMS) patients. It focuses on comparing post-traumatic stress symptoms (PTSS), post-traumatic growth (PTG), and resilience between BMS patients and Controls.

METHODS

A total of 100 BMS patients and 100 Controls from five Italian centers participated in this observational cross-sectional study. They completed several assessments, including the General Health Questionnaire, Depression Anxiety and Stress Scale, Insomnia Severity Index, National Stressful Events Survey Short Scale, Impact of Event Scale-Revised, Post Traumatic Growth Inventory Short Form, and Connor-Davidson Resilience Scale.

RESULTS

BMS patients had significantly higher stress, anxiety, and depression (DASS-21 score) and post-traumatic stress symptoms (IES-R-6 score), particularly in terms of intrusive thoughts. They showed lower post-traumatic growth (PTGI-SF score) compared to Controls. The resilience scale (CDRS-10) was a key predictor of PTG in both groups, explaining a significant variance in PTGI-SF scores.

CONCLUSIONS

BMS patients experienced heightened post-traumatic stress, stress, anxiety, and depression during the COVID-19 pandemic, with reduced post-traumatic growth. This highlights the need to prioritize their psychological well-being, focusing on stress management and fostering post-traumatic growth in challenging times.

Compensatory latency time delays during consecutive perturbations in older adults with and without kinesiophobia

BACKGROUND

Fear of movement has been related to lower limb activation patterns in older adults. However, insight into consecutive perturbations on stepping strategy while considering fall-related confidence is unknown.

RESEARCH QUESTION

Are there latency time delays following three consecutive slip perturbations between subjects with and without kinesiophobia when considering limb dominance and fall efficacy differences?

METHODS

There were 15 older adults with kinesiophobia and 15 age- and body mass index (BMI)-matched control subjects. The subjects stood on the platform during three consecutive perturbations (250, 300, and 400 msec excursions), which were produced by a Bertec device. The subjects completed questionnaires to evaluate the psychological features of their fall-related fear (Tampa Scale for Kinesiophobia: TSK) as well as the modified fall efficacy scale (FES). The latency times (msec) measured the time it took for a subject to respond to a translation.

RESULTS

Overall, the results of the FES demonstrated a moderate negative association with the TSK (r = -0.52, p = 0.004). There was a significant group difference for the FES (t = 2.78, p = 0.01). The FES demonstrated significant positive correlation coefficients (ranging from 0.40 to 0.51) and significant negative correlation coefficients (ranging from -0.41 to -0.61), except for the slow perturbations. The groups demonstrated a significant interaction on consecutive latency times and limb side (F = 5.84, p = 0.02). The latency time during the fast perturbations on the dominant limb (F = 5.53, p = 0.02) was significantly shorter in the kinesiophobia group.

SIGNIFICANCE

The control group demonstrated confidence during fall-related activities, but the latency times were significantly different between groups when considering the dominant limb following repeated slip perturbations. The kinesiophobia group demonstrated shorter latency times on the dominant limb to protect against potential fall-risks from perturbations. The group interactions on limb side and consecutive perturbations need to be considered with fall-related confidence and improved standing balance in older adults with kinesiophobia.

The prevalence of chronic pain in adolescents in Central Switzerland: A cross- sectional school-based study protocol

BACKGROUND

Chronic pain is associated with substantial personal suffering and societal costs and is a growing healthcare concern worldwide. While chronic pain has been extensively studied in adults, limited data exists on its prevalence and impact in adolescents. Understanding the prevalence and impact of chronic pain and pain beliefs in adolescents is crucial for developing effective prevention and treatment strategies. This study aims to estimate the prevalence, characteristics, and impact of chronic pain, and explore adolescents' knowledge and beliefs about pain.

METHODS

This is an observational cohort study of school-going adolescents aged 11 to 17 years in Central Switzerland. The study will estimate the point prevalence, characteristics (location, intensity, frequency, duration) and impact (PROMIS Pediatric Short Form v2.0 -Pain Interference Scale, PPIS) of chronic pain in school-going adolescents. We will also measure and investigate pupils' beliefs about pain (Concept of Pain Inventory (COPI)). Data will be collected through manual and digital self-report questionnaires and from participants in primary, secondary, and high schools between September 2023 and January 2024.

ANALYSES

The primary analyses will utilise descriptive statistics to estimate the point prevalence, characteristics, and impact of chronic pain. Secondary analyses will analyse associations and correlations between chronic pain, impact of pain and beliefs about pain.

OUTCOMES

This study will provide an estimate of the prevalence, characteristics and impact of chronic pain in adolescents in Central Switzerland and a measure of adolescents' understanding and beliefs about pain. In doing so, this study will provide insights into the scale of chronic pain as a public health concern. By understanding adolescents' pain beliefs and their influence on pain experience, this study can contribute to the development of educational approaches to enhance adolescents' knowledge and understanding of pain in order to optimise the prevention and treatment of chronic pain in adolescents. The findings may be useful to healthcare professionals and funders, policymakers, and researchers involved in the prevention, assessment, and treatment of pain in adolescents.

Characterizing Extreme Phenotypes for Pain Interference in Persons With Chronic Pain Following Traumatic Brain Injury: A NIDILRR and VA TBI Model Systems Collaborative Project

OBJECTIVE

To define and characterize extreme phenotypes based on pain interference for persons with chronic pain following traumatic brain injury (TBI).

SETTING

Eighteen Traumatic Brain Injury Model System (TBIMS) Centers.

PARTICIPANTS

A total of 1762 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-up interview.

PRIMARY MEASURES

The Brief Pain Inventory (BPI) interference scale, sociodemographic, injury, functional outcome, pain, and treatment characteristics.

RESULTS

Participants were predominantly male (73%), White (75%), middle-aged (mean 46 years), and who were injured in motor vehicle accidents (53%) or falls (20%). Extreme phenotypes were identified based on upper and lower 25th percentiles to create low-interference ( n = 441) and high-interference ( n = 431) extreme phenotypes. Bivariate comparisons found several sociodemographic, injury, function, pain, and treatment differences between extreme phenotype groups, including significant differences ( P < .001) on all measures of concurrent function with those in the low-interference extreme phenotype experiencing better function than those in the high-interference extreme phenotype. Lasso regression combined with logistic regression identified multivariable predictors of low- versus high-interference extreme phenotypes. Reductions in the odds of low- versus high-interference phenotypes were significantly associated with higher pain intensity (odds ratio [OR] = 0.33), having neuropathic pain (OR = 0.40), migraine headache (OR = 0.41), leg/feet pain (OR = 0.34), or hip pain (OR = 0.46), and more pain catastrophizing (OR = 0.81).

CONCLUSION

Results suggest that for those who experience current chronic pain, there is high variability in the experience and impact of pain. Future research is needed to better understand how pain experience impacts individuals with chronic pain and TBI given that pain characteristics were the primary distinguishing factors between phenotypes. The use of extreme phenotypes for pain interference may be useful to better stratify samples to determine efficacy of pain treatment for individuals with TBI.

Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models

Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.

A Confirmatory Factor Analysis of the 'Return to Duty Readiness Questionnaire'

The Readiness to Return to Duty Questionnaire (RDRQ) is a recently developed screening instrument for detecting fear-avoidance behavior in a military musculoskeletal pain population. The RDRQ was developed based on the Fear-Avoidance Model which postulates four factors resulting in overall fear-avoidance behavior. While research investigating the factor structure of the RDRQ does not exist, research investigating the factor structure of other measures of fear avoidance have found evidence of one and two factor solutions. In the present paper we assess the adequacy of the proposed factor structure of the RDRQ using confirmatory factor analysis. The results favor a three-factor model. Theoretical implications for research using the RDRQ are discussed.

Development and validation of a military fear avoidance questionnaire

Chronic pain due to musculoskeletal injury is one of the leading causes of disability and reduced combat readiness in the U.S. Army. Unidimensional pain management systems are not effective in addressing the complex phenomenon of pain-related disability. Growing evidence has supported use of the Fear Avoidance Model (FAM) as a suitable model to address pain-related disability and chronicity from a multidimensional pain neuroscience approach. While several fear avoidance measurement tools exist, one that addresses the complexity of the Army environment encouraged the authors to develop and test the reliability and validity of a military specific questionnaire. This study developed and validated an Army specific fear avoidance screening, the Return to Duty Readiness Questionnaire (RDRQ), which subsequently demonstrated good psychometric properties. Reliability coefficients demonstrate high internal consistency values both during pilot study (α = 0.96) and validation study (α = 0.94, ωt = 0.94). A Correlation Coefficient of 0.74 when compared with the Fear Avoidance Components Scale (FACS) suggests good concurrent validity. Future study should include replication in a new army population, investigation of responsiveness, test-retest reliability, structural validity and establishing severity scores with minimal clinically important differences to enhance utility.

Pain-related disability, PTSD symptoms, and mood among a comorbid chronic pain and PTSD sample prior to and during the COVID-19 pandemic

There is a knowledge gap when treating comorbid chronic pain and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic. Addressing this gap, 169 individuals (57.4% female), aged 39.8 years were recruited based on levels of pain-related disability and PTSD symptoms. Participants were assessed prior to, and during, the COVID-19 pandemic. Improvements in pain-related disability were marginally attenuated for the comorbid group, compared to the chronic pain group. Results show that some condition-specific symptoms may not have been affected by the COVID-19 pandemic. Cautious interpretation is warranted due to only two time points and the lack of a diverse sample.

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

OBJECTIVE

The novel coronavirus (2019; CV-19) is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder (PTSD). However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD.

METHODS

Prior to the national response to the pandemic (January 10-24, 2020), participants were screened for pain-related disability (Oswestry Disability Index; ODI) and PTSD symptoms (Posttraumatic Checklist for DSM-5; PCL-5), and on the basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic (May 5-May 13, 2020), participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic.

RESULTS

A total of 110 participants (54.55% women), aged 42.19 (SD = 13.16), completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group.

CONCLUSION

The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic.