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Greenlee TA, George SZ, Pickens B, Rhon DI. Risk-stratified Care Improves Pain-related Knowledge and Reduces Psychological Distress for Low Back Pain: A Secondary Analysis of a Randomized Trial. Clin Orthop Relat Res 2025; 483:607-620. [PMID: 39842027 PMCID: PMC11936572 DOI: 10.1097/corr.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 11/21/2024] [Indexed: 01/24/2025]
Abstract
BACKGROUND A number of efforts have been made to tailor behavioral healthcare treatments to the variable needs of patients with low back pain (LBP). The most common approach involves the STarT Back Screening Tool (SBST) to triage the need for psychologically informed care, which explores concerns about pain and addresses unhelpful beliefs, attitudes, and behaviors. Such beliefs that pain always signifies injury or tissue damage and that exercise should be avoided have been implied as psychosocial mediators of chronic pain and can impede recovery. The ability of physical therapy interventions guided by baseline stratification for risk of persistent LBP or related functional limitations to improve unhelpful pain beliefs has not been well assessed. Because treatments are aimed at addressing these beliefs, understanding a bit more about the nature of beliefs about pain (for example, attitudes and knowledge) might help us understand how to better tailor this care or even our risk-stratification approaches for future treatment of patients with LBP. QUESTIONS/PURPOSES (1) Did patients assigned to receive risk-stratified care score higher on an assessment of pain science knowledge? (2) Did patients assigned to receive risk-stratified care have fewer unhelpful attitudes related to pain? (3) Did patients assigned to receive risk-stratified care have less pain-associated psychological distress? (4) Regardless of intervention received, is baseline SBST risk category (low, medium, or high) associated with changes in attitudes and knowledge about pain? METHODS This is a secondary analysis of short-term changes in pain beliefs following the 6-week treatment phase of a randomized controlled trial that examined the effectiveness of a risk-stratified physical therapy intervention on pain-related disability at 1 year. Between April 2017 and February 2020, a total of 290 patients in the Military Health System seeking primary care for LBP were enrolled in a trial comparing a behavioral-based intervention to usual care. The intervention involved psychologically informed physical therapy using cognitive behavioral principles and included tailored education, graded exercise, and graded exposure. Individuals assigned to usual care followed treatment plans set forth by their primary care provider. Thirty-one patients were removed from Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool analyses due to missing assessments at 6 weeks (n = 15 intervention; n = 16 usual care). This resulted in 89% (259 of 290) of participants included for secondary analysis, with no difference in baseline demographic characteristics between groups. The usual-care group comprised 50% of the total study group (129 of 259), with a mean age of 34 ± 9 years; 67% (87 of 129) were men. The risk-stratified care group comprised 50% (130 of 259) of the total study group, with a mean ± SD age of 35 ± 8 years; 64% (83 of 130) were men. Six additional individuals were removed from Survey of Pain Attitudes harm scale (SOPA-h) and revised Neurophysiology of Pain Questionnaire (rNPQ) analyses for missing baseline data (n = 1 intervention) and 6-week data (n = 2 intervention; n = 3 usual care). The rNPQ captured current pain science knowledge, the SOPA-h examined patient attitudes about pain (the extent of beliefs that pain leads to damage and that movement is harmful), and the OSPRO-YF assessed patients for yellow flag clinical markers of pain-related psychological distress across 11 constructs within domains of negative mood, fear avoidance, and positive affect/coping indicative of elevated vulnerability and decreased resilience. Outcomes were assessed at baseline and 6 weeks, and data were analyzed per protocol. We assessed between-group differences at 6 weeks using linear mixed-effects models of pain attitudes and knowledge and related distress, controlling for age, gender, and baseline pain. Regardless of treatment group, we also analyzed differences in rNPQ and SOPA-h scores at 6 weeks based on SBST risk category (low versus medium or high) using generalized linear (Gaussian) regression models. RESULTS Risk-stratified treatment was associated with improvements in pain knowledge (rNPQ mean difference 6% [95% confidence interval (CI) 1% to 11%]; p = 0.01) and a reduction in indicators of pain-associated psychological distress (OSPRO-YF mean difference -1 [95% CI -2 to 0]; p = 0.01) at 6 weeks compared with usual care. There was no difference between groups for SOPA-h score at 6 weeks (mean difference -0.2 [95% CI -0.3 to 0.0]; p = 0.09). Patients with medium- or high-risk scores on the SBST, regardless of intervention, improved slightly more on SOPA-h (β = -0.31; p < 0.01) but not rNPQ (β = 0.02; p = 0.95) than those scoring low risk. CONCLUSION Patients receiving risk-stratified care showed small improvements in pain knowledge and reductions in pain-related psychological distress at 6 weeks, immediately after intervention, compared with usual care. Implementation of this risk-stratified care approach for LBP was able to change patients' perceptions about pain and reduce some of their psychological distress beyond what was achieved by usual care in this setting. As these factors are believed to favorably mediate treatment outcomes, future studies should investigate whether these improvements persist over the long term, determine how they influence clinical outcomes, and explore alternatives for risk stratification and treatment to elicit greater improvements.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Tina A. Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Steven Z. George
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
- Departments of Orthopaedic Surgery and Population Health Sciences, Duke Clinical Research Institute, School of Medicine, Duke University, Durham, NC, USA
| | - Bryan Pickens
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
- Army-Baylor University Doctor of Physical Therapy Program, Fort Sam Houston, TX, USA
| | - Daniel I. Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
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Luedtke D, Wachholtz A. The relationship between spiritual wellbeing, pain catastrophizing, and pain perception: An exploration of pain perception in individuals with chronic pain. J Health Psychol 2025:13591053251314937. [PMID: 39972260 DOI: 10.1177/13591053251314937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
Spiritual wellbeing correlates with improved pain perception. We hypothesize that pain catastrophizing, which correlates with worsened pain, partially explains this relationship. In this cross-sectional, human laboratory-based study, 120 US Americans with chronic pain completed self-report measures of spiritual wellbeing, pain catastrophizing, and their subconstructs. A cold pressor task measured pain perception (i.e. pain sensitivity and pain tolerance). Multiple regressions evaluated the relationship between spiritual wellbeing (and its subconstructs) and pain perception with and without the inclusion of pain catastrophizing (and its subconstructs). No direct relationships were found between spiritual wellbeing or its subconstructs and pain sensitivity, although helplessness significantly altered regression coefficients. Spiritual wellbeing, meaning, and peace associated less strongly with pain tolerance controlling for pain catastrophizing, helplessness, and (for peace) magnification. This shows that many of the links between spiritual wellbeing and pain perception are indirect, through pain catastrophizing and especially helplessness.
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Zeliadt SB, Coggeshall S, Zhang X, Rosser EW, Reed Ii DE, Elwy AR, Bokhour BG, Toyama JA, Taylor SL. How initial perceptions of the effectiveness of mind and body complementary and integrative health therapies influence long-term adherence in a pragmatic trial. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:S54-S63. [PMID: 39514886 PMCID: PMC11548863 DOI: 10.1093/pm/pnae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/21/2024] [Accepted: 07/11/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE Beliefs and perceptions about pain intervention effectiveness when initiating a therapy may influence long-term engagement. This study examines how early perceived effectiveness of complementary and integrative health therapies impacts long-term engagement in a pragmatic trial context. PARTICIPANTS Veterans with chronic musculoskeletal pain participating in a pragmatic trial of provider-delivered complementary and integrative health therapies (acupuncture, chiropractic care, or massage therapy) used alone compared to combining those therapies with self-care therapies (yoga, Tai Chi/Qigong, or meditation). This analysis focuses on 1713 participants using self-care therapies at baseline. SETTING 18 Veterans Healthcare Administration Medical Facilities. DESIGN Prospective cohort study. METHODS Predictors of total self-care complementary and integrative health therapy sessions over a 6-month assessment period were assessed using linear regression to determine how strongly perceptions of initial therapy effectiveness was associated with total utilization. Perception of initial therapy effectiveness was assessed at study entry across four domains (pain, mental health, fatigue, and general well-being). RESULTS In total, 56% (1032/1713) of Veterans reported a positive perceived effectiveness of their recent complementary and integrative health therapy use at study initiation. Older individuals and those using meditation were more likely to report early positive perceptions. Mean number of therapy sessions over the 6-month study was 11 (range 1 to 168). Early positive perceptions had a small effect on overall use, increasing mean sessions by 2.5 (1.3 to 3.6). Other factors such as recent physical therapy use and distance to primary care explained more variation in total utilization. CONCLUSIONS Pragmatic pain trials should examine factors associated with engagement across assigned treatment protocols, especially if any of the treatment protocols being tested are sensitive to long-term engagement.
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Affiliation(s)
- Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA 98108, United States
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, United States
| | - Scott Coggeshall
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - Xiaoyi Zhang
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA 98108, United States
- Department of Biomedical Informatics and Medical Information, School of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Ethan W Rosser
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - David E Reed Ii
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA 98108, United States
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, United States
| | - A Rani Elwy
- Center for Health Optimization and Implementation Research, VA Bedford Health Care System, Bedford, MA 01730, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
| | - Barbara G Bokhour
- Center for Health Optimization and Implementation Research, VA Bedford Health Care System, Bedford, MA 01730, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Joy A Toyama
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Health Care System, Los Angeles, CA 90073, United States
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Health Care System, Los Angeles, CA 90073, United States
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, United States
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
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Veljkovic A, Gagne O, Abuhantash M, Younger ASE, Symes M, Penner MJ, Wing KJ, Syed KA, Lau J. High Pain Catastrophizing Scale Predicts Lower Patient-Reported Outcome Measures in the Foot and Ankle Patient. Foot Ankle Spec 2024; 17:501-509. [PMID: 35607813 PMCID: PMC11667948 DOI: 10.1177/19386400221093865] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postoperative outcomes may be affected by the patient's preoperative morbidity. It is hypothesized that patient's pain catastrophization prior to foot and ankle surgery may affect their patient-reported outcomes. Methods: This study prospectively assessed a consecutive cohort of 46 patients undergoing foot and ankle reconstruction to describe the relationship between Pain Catastrophizing Scale (PCS) and patient-reported outcomes measured by 12-item Short Form Health Survey and Foot and Ankle Outcome Score (FAOS). RESULTS The 1-year postoperative FAOS pain, activities of daily living, and quality of life scores correlated significantly with all baseline PCS subcategories. We found that the mental domain of the SF-12 had a statistically significant correlation with the rumination and helplessness PCS subcategories. CONCLUSION This study showed a significant association between a high preoperative PCS and a worse 1-year FAOS. As such, catastrophization could be screened for and potentially treated preoperatively to improve patient-reported outcomes in elective foot and ankle surgery. LEVEL OF EVIDENCE Therapeutic, Level III Evidence.
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Affiliation(s)
- Andrea Veljkovic
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Oliver Gagne
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | | | - Alastair S. E. Younger
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Michael Symes
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Murray J. Penner
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Kevin J. Wing
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Khalid A. Syed
- Arthritis Program, Toronto Western Hospital and Research Institute, University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Johnny Lau
- Arthritis Program, Toronto Western Hospital and Research Institute, University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Rajput K, Howie BA, Danesh JA, Zhao X, Lin HM, Yanez D, Chow R. Relationship of pain relief with catastrophizing following interventional pain procedures for low back pain. Reg Anesth Pain Med 2024:rapm-2023-105247. [PMID: 38744446 DOI: 10.1136/rapm-2023-105247] [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: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Catastrophizing is associated with worse pain outcomes after various procedures suggesting its utility in predicting response. However, the stability of pain catastrophizing as a static predictor has been challenged. We assess, among patients undergoing steroid injections for chronic low back pain (cLBP), whether catastrophizing changes with the clinical response to pain interventions. METHODS This prospective study enrolled patients undergoing fluoroscopic-guided injections for cLBP. Patients filled out Brief Pain Inventory (BPI) and Pain Catastrophizing Scale (PCS) at baseline and 1-month follow-up. We assessed the change in PCS scores from pre-injection to post-injection and examined its predictors. We also examined the correlation of various domains of BPI, such as pain severity and effect on Relationships, Enjoyment, and Mood (REM), with PCS scores at baseline and follow-up. RESULTS 128 patients were enrolled. Mean (SD) PCS and pain severity scores at baseline were 22.38 (±13.58) and 5.56 (±1.82), respectively. Follow-up PCS and pain severity scores were 19.76 (±15.25) and 4.42 (±2.38), respectively. The change in PCS pre-injection to post-injection was not significant (p=0.12). Multiple regression models revealed baseline PCS and REM domain of BPI as the most important predictors of change in PCS after injection. Pain severity, activity-related pain, age, sex, insurance status, depression, prior surgery, opioid use, or prior interventions did not predict change in PCS score. In correlation analysis, change in PCS was moderately correlated with change in pain (r=0.38), but weakly correlated with baseline pain in all pain domains. CONCLUSIONS PCS showed non-significant improvement following steroid injections; the study was not powered for this outcome. Follow-up PCS scores were predicted by the REM domain of BPI, rather than pain severity. Larger studies are needed to evaluate a statistically significant and clinically meaningful change in catastrophizing scores following pain interventions.
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Affiliation(s)
- Kanishka Rajput
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin A Howie
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Julius Araash Danesh
- Department of Pain Medicine, West Virginia University-Health Sciences Campus, Morgantown, West Virginia, USA
| | - Xiwen Zhao
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Yanez
- Duke University, Durham, North Carolina, USA
| | - Robert Chow
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
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Fonseca das Neves J, Kornacka M, Serra E, Rollin N, Kosinski T, Maréchal V, Jehel L, Rusinek S. The impact of rumination on fibromyalgia pain after physical activity: an experimental study. Sci Rep 2023; 13:20523. [PMID: 37993555 PMCID: PMC10665397 DOI: 10.1038/s41598-023-47414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023] Open
Abstract
Some fibromyalgia (FM) patients engage in rumination (i.e. a chain of repetitive, passive and relatively uncontrollable thoughts focused on negative content) to cope with the pain and discomfort of daily activities. The partial model of rumination in chronic pain suggests that rumination processes may play a causal role in maintaining pain. Rumination might also be one of the key factors interfering with the reestablishment of adapted physical activity. The objective of this study was to test how rumination vs. distraction induction influence FM patients' pain intensity, discomfort linked to pain, and affect after physical activity. Forty-seven participants with a diagnosis of FM were randomly assigned to undergo distraction induction vs. rumination induction after performing a physical activity in ecological setting. Their pain intensity, pain-related discomfort, and affect were measured at the baseline, after physical activity, and after rumination versus distraction induction. A series of mixed-design ANOVAs showed that rumination induction after physical activity impairs patients' recovery in terms of pain intensity and discomfort, but not affect, as compared to the distraction condition. In conclusion, participants with fibromyalgia who engage in rumination following a physical activity recover less from their pain experience as compared to distraction induction. These results are consistent with the partial model of rumination in chronic pain and support the idea that rumination may play a causal role in the development and maintenance of pain.
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Affiliation(s)
| | - Monika Kornacka
- Emotion Cognition Lab, SWPS University, Technikow 9, 40-326, Katowice, Poland.
| | - Eric Serra
- Centre d'étude et de Traitement de la Douleur, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
- Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, F-59000, Lille, France
- UFR Santé, Université de Picardie Jules Verne, Amiens, France
| | - Noémie Rollin
- Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, F-59000, Lille, France
- Consultation de la Douleur, Centre Hospitalier de Soissons, Soissons, France
| | - Thierry Kosinski
- Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, F-59000, Lille, France
| | - Virginie Maréchal
- Psychiatrie de Liaison, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Louis Jehel
- Psychiatrie de Liaison, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
- UFR Santé, Université de Picardie Jules Verne, Amiens, France
- Equipe MOODS-IPSOM, U1018, CESP/INSERM, 94807, Villejuif Cedex, France
| | - Stéphane Rusinek
- Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, F-59000, Lille, France
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Sattin D, Parma C, Lunetta C, Zulueta A, Lanzone J, Giani L, Vassallo M, Picozzi M, Parati EA. An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders. Brain Sci 2023; 13:1410. [PMID: 37891779 PMCID: PMC10605253 DOI: 10.3390/brainsci13101410] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.
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Affiliation(s)
- Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Chiara Parma
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department-ALS Unit, Via Camaldoli 64, 20138 Milan, Italy;
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Luca Giani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Marta Vassallo
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Eugenio Agostino Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
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Roger AH, Gudleski GD, Quigley BM, Zvolensky MJ, Lackner JM. Pain Catastrophizing and Clinical Outcomes Among Patients Receiving a Novel Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: An Experimental Therapeutics Approach. Behav Ther 2023; 54:623-636. [PMID: 37330253 DOI: 10.1016/j.beth.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) condition treated by GI and primary care physicians. Although IBS symptoms (abdominal pain, bowel problems) are generally refractory to medical therapies, consistent research has shown that they improve following cognitive-behavioral therapy (CBT). Notwithstanding empirical support for CBT, there is less research explicating the reasons for why or how it works. Like other pain disorders, the focus on change mechanisms for behavioral pain treatments has focused on pain-specific cognitive-affective processes that modulate pain experience, few of which are more important than pain catastrophizing (PC). The fact that PC changes are seen across treatments of differing theoretical and technical orientation, including CBT, yoga, and physical therapy, suggests that it may be a nonspecific (vs. theory-based) change mechanism akin to therapeutic alliance and treatment expectancy. Therefore, the current study examined change in PC as a concurrent mediator of IBS symptoms severity, global GI symptom improvement, and quality of life among 436 Rome III-diagnosed IBS patients enrolled in a clinical trial undergoing two dosages of CBT versus a nonspecific comparator emphasizing education and support. Results from structural equation modeling parallel process mediation analyses suggest that reduction in PC during treatment are significantly associated with improvement in IBS clinical outcomes through 3-month follow-up. Results from the current study provide evidence that PC may be an important, albeit nonspecific change mechanism, during CBT for IBS. Overall, reducing the emotional unpleasantness of pain through cognitive processes is associated with improved outcomes for IBS.
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Yang SY, Woon EYS, Griva K, Tan BY. A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population. Clin Orthop Relat Res 2023; 481:874-884. [PMID: 36580492 PMCID: PMC10097569 DOI: 10.1097/corr.0000000000002526] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/21/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND A patient's experience with knee osteoarthritis (OA) is influenced by many psychosocial contributors that can influence the impact of pain. Such factors are known to explain some of the discordance between objective clinical parameters and patient-reported levels of disability and treatment effectiveness. However, few data are available to help clinicians understand the psychosocial factors that apply to the world's many Asian populations. Insights gained from a qualitative study in such a population may support targeted interventions. QUESTIONS/PURPOSES In this qualitative study involving a group of Asian patients with knee OA in Singapore, we asked: (1) What psychologic factors contribute to patients' experiences, rehabilitation, and recovery? (2) What social factors contribute to patients' experiences, rehabilitation, and recovery? METHODS Semistructured interviews eliciting broad patient experiences of managing knee OA were conducted in an urban, referral-based tertiary hospital in central Singapore. Patients were recruited if they met either of the following criteria: Kellgren-Lawrence grade ≥ 3 (minimum of one knee); Knee Injury and Osteoarthritis Outcome Score ≤ 60; or the Pain average (P), interference with Enjoyment of life (E), and interference with General activity (G) (PEG) ≥ 5. All patients had a clinical diagnosis of knee OA, were ambulatory in the community with or without a walking aid, had not undergone partial arthroplasty or TKA, were prescribed nonsurgical treatment, and were conversant in either English or Mandarin. Forty-six patients (30 women and 16 men, mean age 64 years old) were recruited for this study. A thematic analysis with elements of grounded theory and framework analysis was performed using a deductive approach. Psychologic influences specific to patients' behavioral and emotional responses to pain, as well as social factors known to have an impact on the experience of managing knee OA, were identified in the interview transcripts and coded according to established factors from earlier research. An inductive thematic analysis was then applied to the remaining transcripts to identify new themes that emerged from the data. Thematic saturation was attained when study team members agreed data and thematic sufficiency were met in the 46 transcripts. The study team discussed and deemed the 46 transcripts to contain sufficient insights for a reasonably clear understanding of the codes and development of themes to answer the study's research questions. RESULTS Six main themes related to psychosocial influences on pain emerged. Psychologic factors were "loss of face" because of knee OA, anticipation and avoidance of pain and suffering, and a vicious cycle of negative emotional experiences. The social factors we identified were social and family support, workplace environment and employment uncertainty, and built environment (patients' ability to navigate manmade structures and facilities). CONCLUSION Psychosocial factors have an important impact on patients' physical, psychologic, and social functioning. Although several of our findings have been addressed previously, the phenomenon of loss of face and the wide spectrum of social and family support dynamics found in our Asian patients with knee OA were new findings. With loss of face, patients were concerned about how others would view the change in them, including movement changes because of knee OA. They appeared to associate the use of walking canes with major disability, loss of respect, and being discriminated against by others, motivating patients to "save face" by dissociating themselves from those stigmas, even at the cost of mobility and independence. An interplay of complex cultural processes (perceived social roles and contributions to family, desire to avoid burdening family, help-seeking behavior, and the preference for unsolicited social support) underpinned by the value of collectivism impacted the behaviors and choices patients exhibited. CLINICAL RELEVANCE With knowledge about the impact of culturally relevant psychosocial factors on the experience and outcomes of patients with knee OA, clinicians will be able to screen and actively explore these factors more effectively. Especially important themes include pain perception (paying close attention to signs of pain catastrophizing and negative affect), presence of chronic illness shame associated with a diagnosis of knee OA (including the stigma associated with using a walking aid), and level of social support received and contributions of a patient's built environment to kinesiophobia. For patients who are still working, the presence of workplace stressors and management of these stressors should also be explored. Where possible, screening tools that measure psychosocial factors such as pain catastrophizing and emotional distress can also be used as an added layer of screening in busy clinical settings.
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Affiliation(s)
- Su-Yin Yang
- Psychology Service, Woodlands Health, National Health Group, Singapore, Singapore
| | - Eugene Yong Sheng Woon
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bryan Yijia Tan
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore
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10
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Tan HS, Plichta JK, Kong A, Tan CW, Hwang S, Sultana R, Wright MC, Sia ATH, Sng BL, Habib AS. Risk factors for persistent pain after breast cancer surgery: a multicentre prospective cohort study. Anaesthesia 2023; 78:432-441. [PMID: 36639918 DOI: 10.1111/anae.15958] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/15/2023]
Abstract
Identifying factors associated with persistent pain after breast cancer surgery may facilitate risk stratification and individualised management. Single-population studies have limited generalisability as socio-economic and genetic factors contribute to persistent pain development. Therefore, this prospective multicentre cohort study aimed to develop a predictive model from a sample of Asian and American women. We enrolled women undergoing elective breast cancer surgery at KK Women's and Children's Hospital and Duke University Medical Center. Pre-operative patient and clinical characteristics and EQ-5D-3L health status were recorded. Pain catastrophising scale; central sensitisation inventory; coping strategies questionnaire-revised; brief symptom inventory-18; perceived stress scale; mechanical temporal summation; and pressure-pain threshold assessments were performed. Persistent pain was defined as pain score ≥ 3 or pain affecting activities of daily living 4 months after surgery. Univariate associations were generated using generalised estimating equations. Enrolment site was forced into the multivariable model, and risk factors with p < 0.2 in univariate analyses were considered for backwards selection. Of 210 patients, 135 (64.3%) developed persistent pain. The multivariable model attained AUC = 0.807, with five independent associations: age (OR 0.85 95%CI 0.74-0.98 per 5 years); diabetes (OR 4.68, 95%CI 1.03-21.22); pre-operative pain score at sites other than the breast (OR 1.48, 95%CI 1.11-1.96); previous mastitis (OR 4.90, 95%CI 1.31-18.34); and perceived stress scale (OR 1.35, 95%CI 1.01-1.80 per 5 points), after adjusting for: enrolment site; pre-operative pain score at the breast; pre-operative overall pain score at rest; postoperative non-steroidal anti-inflammatory drug use; and pain catastrophising scale. Future research should validate this model and evaluate pre-emptive interventions to reduce persistent pain risk.
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Affiliation(s)
- H S Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - J K Plichta
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A Kong
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - C W Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - S Hwang
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - R Sultana
- Centre for Quantitative Medicine, Singapore
| | - M C Wright
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - A T H Sia
- KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - B L Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - A S Habib
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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11
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Scheidegger A, Gómez Penedo JM, Blättler LT, Aybek S, Bischoff N, Grosse Holtforth M. Improvements in pain coping predict treatment success among patients with chronic primary pain. J Psychosom Res 2023; 168:111208. [PMID: 36898317 DOI: 10.1016/j.jpsychores.2023.111208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Given the increasing incidence and prevalence of chronic pain, effective treatments for chronic pain are needed. This study aimed to investigate the role of cognitive and behavioral pain coping regarding the prediction of treatment outcomes among inpatients with chronic primary pain participating in an interdisciplinary multimodal treatment program. METHODS At intake and discharge, 500 patients with chronic primary pain completed questionnaires on pain intensity, pain interference, psychological distress, and pain processing. RESULTS Patients' symptoms, cognitive and behavioral pain coping improved significantly after treatment. Similarly, separate cognitive and behaviroal coping skills improved significantly after treatment. Hierarchical linear models revealed no significant associations of pain coping with reductions in pain intensity. Whereas the overall level and improvements in cognitive pain coping predicted reductions in pain interference and psychological distress, the overall level and improvements in behavioral pain coping were associated with reductions in pain interference alone. DISCUSSION Since pain coping seems to influence both pain interference and psychological distress, improving cognitive and behavioral pain coping during an interdisciplinary multimodal pain treatment seems to be a key component in the successful treatment of inpatients with chronic primary pain, enabling them to function better physically and mentally despite their chronic pain. Clinically, it might be worth fostering and exercising cognitive restructuring as well as action planning in treatment to reduce both pain interference and psychological distress levels post-treatment. In addition, practicing relaxation techniques might help reduce pain interference post-treatment, whereas making experiences of personal competence might help reduce psychological distress post-treatment.
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Affiliation(s)
- Alina Scheidegger
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Psychology, University of Bern, Bern, Switzerland.
| | | | - Larissa Tatjana Blättler
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Selma Aybek
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Nina Bischoff
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Martin Grosse Holtforth
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Psychology, University of Bern, Bern, Switzerland.
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12
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McConaghy K, Rullan P, Murray T, Molloy R, Heinberg LJ, Piuzzi NS. Team Approach: Management of Mental Health in Orthopaedic Patients. JBJS Rev 2023; 11:01874474-202302000-00003. [PMID: 36763707 DOI: 10.2106/jbjs.rvw.22.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
» Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist. » The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures. » Psychological issues are multifaceted and require treatment tailored to each individual patient. Therefore, close communication between all members of the care team is required to create and execute the perioperative plan.
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pedro Rullan
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor Murray
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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13
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Chen JA, Anderson ML, Cherkin DC, Balderson BH, Cook AJ, Sherman KJ, Turner JA. Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:282-303. [PMID: 36180008 PMCID: PMC9898119 DOI: 10.1016/j.jpain.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with CLBP (N = 297), we examined baseline characteristics that moderated treatment effects or were associated with improvement regardless of treatment. Outcomes included 8-week function (modified Roland Disability Questionnaire), pain bothersomeness (0-10 numerical rating scale), and depression (Patient Health Questionnaire-8). There were differences in the effects of CBT versus MBSR on pain based on participant gender (P = .03) and baseline depressive symptoms (P = .01), but the only statistically significant moderator after Bonferroni correction was the nonjudging dimension of mindfulness. Scores on this measure moderated the effects of CBT versus MBSR on both function (P = .001) and pain (P = .04). Pain control beliefs (P <.001) and lower anxiety (P < .001) predicted improvement regardless of treatment. Replication of these findings is needed to guide treatment decision-making for CLBP. TRIAL REGISTRATION: The trial and analysis plan were preregistered in ClinicalTrials.gov (Identifier: NCT01467843). PERSPECTIVE: Although few potential moderators and nonspecific predictors of benefits from CBT or MBSR for CLBP were statistically significant after adjustment for multiple comparisons, these findings suggest potentially fruitful directions for confirmatory research while providing reassurance that patients could reasonably expect to benefit from either treatment.
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Affiliation(s)
- Jessica A Chen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Daniel C Cherkin
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
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14
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Effectiveness of a Primary Care Multidisciplinary Treatment for Patients with Chronic Pain Compared with Treatment as Usual. J Clin Med 2023; 12:jcm12030885. [PMID: 36769533 PMCID: PMC9918146 DOI: 10.3390/jcm12030885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
To manage chronic pain, multidisciplinary interventions have been increasingly deployed, mostly in secondary or tertiary care settings. Evidence on the effectiveness of multidisciplinary intervention within primary care is scarce. This study examined the effectiveness of a primary care multidisciplinary treatment for chronic pain compared with treatment as usual (TAU). The intervention consisted of pain neuroscience education and treatment by a GP, psychologist, and physiotherapist. Both groups filled out patient-reported outcome measures at baseline, 6 months, and 12 months. The results indicated there were no statistically significant differences for the primary outcomes of pain intensity, number of pain sites, and health-related quality of life (HR-QoL). There was a statistically significant difference in the secondary outcome perceived health change in favor of the intervention group. None of the other differences were statistically significant. A post-hoc analysis showed that there were statistically significant effects on patients' illness perceptions in favor of the intervention group. Based on the results, the findings do not support effectiveness of a low intensity outpatient multidisciplinary primary care treatment to treat chronic pain compared with TAU. However, as a result of several study limitations, it is considered unwarranted to conclude that multidisciplinary treatment in primary care is not valuable at all.
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15
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Trouvin AP, Carvès S, Rouquette A, Coste J, Meyer S, Colin F, Deleens R, Medkour T, Collet MP, Perrot S, Laroche F. "FastSchool": A single session of an interprofessional pain management program for chronic pain patients inspired by cognitive behavioral therapy. PATIENT EDUCATION AND COUNSELING 2022; 105:3509-3514. [PMID: 36115735 DOI: 10.1016/j.pec.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Multidisciplinary approaches to treating chronic pain have been proven effective. Currently, chronic pain patients face lengthy waitlists in pain medicine departments. To overcome this problem, we developed the "FastSchool" program to educate patients about pain management and treatment. In this study, we evaluated the benefit of a "FastSchool" session on pain and catastrophizing in chronic pain patients. METHODS Included patients had chronic non-cancer pain, no more than 2 visits to a pain medicine department. Patients attended a single 3-hour session, conducted by an interprofessional team. Four topics were addressed: chronic pain mechanisms, pharmacological therapies, physical activity, and the management of analgesics. Patients completed questionnaires at baseline and at 3 months post-session to assess pain interference, pain intensity, and catastrophizing. RESULTS The study population included 88 patients; 71 completed the follow-up questionnaires. Pain interference (p = 0.002), average pain intensity (p = 0.013), and catastrophizing (p < 0.001) decreased 3 months after FastSchool. At M3, 35 % of patients felt their pain had improved based on the Patient Global Impression of Change. CONCLUSION FastSchool, an innovative short-term educational program inspired by cognitive behavioral therapy, showed positive results in reducing pain impact. PRACTICE IMPLICATIONS Implementation of FastSchool in pain medicine departments would reduce waitlist times for non-pharmacological treatment.
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Affiliation(s)
| | | | - Alexandra Rouquette
- Department of Epidemiology and Public Health, Bicêtre Universitary Hospital, Le Kremlin-Bicêtre, France
| | - Joël Coste
- Pain Department, GHU Paris Centre-Cochin, Paris, France; Biostatistics and Epidemiology Unit, GHU Paris Centre-Cochin, Paris, France
| | - Sinja Meyer
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
| | - Faustine Colin
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
| | | | | | | | - Serge Perrot
- Pain Department, GHU Paris Centre-Cochin, Paris, France
| | - Françoise Laroche
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
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16
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Wainwright E, Bevan S, Blyth FM, Khalatbari-Soltani S, Sullivan MJL, Walker-Bone K, Eccleston C. Pain, work, and the workplace: a topical review. Pain 2022; 163:408-414. [PMID: 34294663 DOI: 10.1097/j.pain.0000000000002413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Elaine Wainwright
- Department of Psychology, Bath Spa University, Bath, United Kingdom
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
| | - Steven Bevan
- HR Research Development, Institute for Employment Studies, Brighton, United Kingdom
| | - Fiona M Blyth
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
| | - Saman Khalatbari-Soltani
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
| | | | - Karen Walker-Bone
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
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17
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The Pain Coping Questionnaire short-form: preliminary reliability and validity. Pain Rep 2022; 7:e982. [PMID: 35047713 PMCID: PMC8759611 DOI: 10.1097/pr9.0000000000000982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/29/2021] [Accepted: 11/11/2021] [Indexed: 12/30/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. A brief 16-item format of the Pain Coping Questionnaire was developed and found to have acceptable preliminary reliability and validity. Introduction: The Pain Coping Questionnaire (PCQ) has support for its validity and reliability as a tool to understand how a child copes with pain of an extended duration. However, measure length may limit feasibility in clinical settings. Objectives: The primary goal of this study was to develop a short-form (PCQ-SF) that could be used for screening how children cope with chronic or recurrent pain and examine its reliability and validity. Methods: The PCQ-SF was developed in a stepwise manner. First, a confirmatory factor analysis was computed using an amalgamated data set from the validation studies of the PCQ (N = 1225). Next, ratings from researchers and clinicians were obtained on PCQ item content and clarity (n = 12). Finally, the resulting 16-item short-form was tested in a pediatric sample living with chronic and recurrent pain (65 parent–child dyads; n = 128). Results: The PCQ-SF has acceptable preliminary reliability and validity. Both statistical and expert analyses support the collective use of the 16 items as an alternative to the full measure. Conclusions: The compact format of the PCQ-SF will allow practitioners in high-volume clinical environments to quickly determine a child's areas of strengths and weaknesses when coping with pain. Future research using larger more diverse samples to confirm clinical validity is warranted.
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18
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Mercer Lindsay N, Chen C, Gilam G, Mackey S, Scherrer G. Brain circuits for pain and its treatment. Sci Transl Med 2021; 13:eabj7360. [PMID: 34757810 DOI: 10.1126/scitranslmed.abj7360] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Nicole Mercer Lindsay
- Department of Cell Biology and Physiology, UNC Neuroscience Center, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Biology, CNC Program, Department of Applied Physics, Stanford University, Stanford, CA 94305, USA
| | - Chong Chen
- Department of Cell Biology and Physiology, UNC Neuroscience Center, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gadi Gilam
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Grégory Scherrer
- Department of Cell Biology and Physiology, UNC Neuroscience Center, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,New York Stem Cell Foundation-Robertson Investigator, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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19
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Leemhuis E, Giuffrida V, Giannini AM, Pazzaglia M. A Therapeutic Matrix: Virtual Reality as a Clinical Tool for Spinal Cord Injury-Induced Neuropathic Pain. Brain Sci 2021; 11:1201. [PMID: 34573221 PMCID: PMC8472645 DOI: 10.3390/brainsci11091201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Neuropathic pain (NP) is a chronic, debilitating, and resistant form of pain. The onset rate of NP following spinal cord injuries (SCI) is high and may reduce the quality of life more than the sensorimotor loss itself. The long-term ineffectiveness of current treatments in managing symptoms and counteracting maladaptive plasticity highlights the need to find alternative therapeutic approaches. Virtual reality (VR) is possibly the best way to administer the specific illusory or reality-like experience and promote behavioral responses that may be effective in mitigating the effects of long-established NP. This approach aims to promote a more systematic adoption of VR-related techniques in pain research and management procedures, highlighting the encouraging preliminary results in SCI. We suggest that the multisensory modulation of the sense of agency and ownership by residual body signals may produce positive responses in cases of brain-body disconnection. First, we focus on the transversal role embodiment and how multisensory and environmental or artificial stimuli modulate illusory sensations of bodily presence and ownership. Then, we present a brief overview of the use of VR in healthcare and pain management. Finally, we discus research experiences which used VR in patients with SCI to treating NP, including the most recent combinations of VR with further stimulation techniques.
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Affiliation(s)
- Erik Leemhuis
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Giuffrida
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Anna Maria Giannini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
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20
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Taub CJ, Sturgeon JA, Chahal MK, Kao MC, Mackey SC, Darnall BD. Self-reported traumatic etiology of pain and psychological function in tertiary care pain clinic patients: a collaborative health outcomes information registry (CHOIR) study. Scand J Pain 2021; 20:499-509. [PMID: 32191626 DOI: 10.1515/sjpain-2019-0154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/13/2020] [Indexed: 11/15/2022]
Abstract
Background and aims A sizable body of research has elucidated the significant role of psychological reactions to trauma on pain coping and outcomes. In order to best inform intervention development and clinical care for patients with both trauma and pain at the tertiary care level, greater clarity is needed regarding the magnitude of these effects and the specific pathways through which they may or may not function at the time of first presentation to such a treatment setting. To achieve this, the current study examined the cross-sectional relationships between traumatic etiology of pain, psychological distress (anger, depressive symptoms, and PTSD symptoms), and pain outcomes (pain catastrophizing, physical function, disability status). Methods Using a structural path modeling approach, analyses were conducted using a large sample of individuals with chronic pain (n = 637) seeking new medical evaluation at a tertiary pain management center, using the Collaborative Health Outcomes Information Registry (CHOIR). We hypothesized that the relationships between traumatic etiology of pain and poorer pain outcomes would be mediated by higher levels of psychological distress. Results Our analyses revealed modest relationships between self-reported traumatic etiology of pain and pain catastrophizing, physical function, and disability status. In comparison, there were stronger relationships between indices of psychological distress and pain catastrophizing, but a weaker pattern of associations between psychological distress and physical function and disability measures. Conclusions To the relatively small extent that self-reported traumatic etiology of pain correlates with pain-related outcomes, these relationships appear to be due primarily to the presence of psychiatric symptoms and manifest most notably in the context of psychological responses to pain (i.e. catastrophizing about pain). Implications Findings from this study highlight the need for early intervention for patients with traumatic onset of pain and for clinicians at tertiary pain centers to include more detailed assessments of psychological distress and trauma as a component of comprehensive chronic pain treatment.
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Affiliation(s)
- Chloe J Taub
- University of Miami, Department of Psychology, Coral Gables, FL, USA
| | - John A Sturgeon
- University of Washington School of Medicine, Department of Anesthesiology and Pain Medicine, Seattle, WA, USA
| | - Mandeep K Chahal
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford, CA, USA
| | - Ming-Chih Kao
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford, CA, USA
| | - Sean C Mackey
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford, CA, USA
| | - Beth D Darnall
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford, CA, USA
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21
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Feldmann M, Hein HJ, Voderholzer U, Doerr R, Hoff T, Langs G, Herzog P, Kaiser T, Rief W, Riecke J, Brakemeier EL. Cognitive Change and Relaxation as Key Mechanisms of Treatment Outcome in Chronic Pain: Evidence From Routine Care. Front Psychiatry 2021; 12:617871. [PMID: 34413794 PMCID: PMC8368979 DOI: 10.3389/fpsyt.2021.617871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
Despite effective treatment approaches within the cognitive behavioral framework general treatment effects for chronic pain are rather small to very small. Translation from efficacy trials to naturalistic settings is questionable. There is an urgent need to improve the effectiveness of well-established treatments, such as cognitive-behavior therapy (CBT) and the investigation of mechanisms of change is a promising opportunity. We performed secondary data analysis from routine data of 1,440 chronic pain patients. Patients received CBT in a multidisciplinary setting in two inpatient clinics. Effect sizes and reliable change indices were computed for pain-related disability and depression. The associations between changes in the use of different pain coping skills (cognitive restructuring, activity despite pain, relaxation techniques and mental distraction) and changes in clinical outcomes were analyzed in structural equation models. Pre-post effect sizes range from g = 0.47 (disability) to g = 0.89 (depression). Changes in the use of cognitive restructuring, relaxation and to a lesser degree mental distraction were associated with changes in disability and depression. Effects from randomized trials can be translated to naturalistic settings. The results complement experimental research on mechanisms of change in the treatment of chronic pain and indicate an important role of cognitive change and relaxation as mechanisms of change. Our findings cautiously suggest that clinicians should optimize these processes in chronic pain patients to reduce their physical and emotional disability.
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Affiliation(s)
- Matthias Feldmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Hauke Jeldrik Hein
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Robert Doerr
- Schoen Clinic Berchtesgadener Land, Schönau am Königsee, Germany
| | - Thomas Hoff
- Schoen Clinic Bad Bramstedt, Bad Bramstedt, Germany
| | - Gernot Langs
- Schoen Clinic Bad Bramstedt, Bad Bramstedt, Germany
| | - Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Tim Kaiser
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
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22
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Vallejo MA, Vallejo-Slocker L, Offenbaecher M, Hirsch JK, Toussaint LL, Kohls N, Sirois F, Rivera J. Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7300. [PMID: 34299758 PMCID: PMC8307804 DOI: 10.3390/ijerph18147300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/27/2022]
Abstract
Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.
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Affiliation(s)
- Miguel A. Vallejo
- Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Laura Vallejo-Slocker
- Psychology Faculty, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Martin Offenbaecher
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Jameson K. Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA;
| | | | - Niko Kohls
- Division of Integrative Health Promotion, University of Applied Science and Arts, 96450 Coburg, Germany;
| | - Fuschia Sirois
- Department of Psychology, University of Sheffield, Sheffield S1 2LT, UK;
| | - Javier Rivera
- Rehumatology Unit, Instituto Provincial de Rehabilitación, Hospital General Universitario “Gregorio Marañón”, 28028 Madrid, Spain;
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23
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Sant'Anna CBM, Caxias FPD, Zuim PRJ, Januzzi MS, Silva EVFD, Turcio KHL. Treatment of Masticatory Muscle Pain with Acupuncture: Is It Necessary to Associate with Occlusal Splints? J Acupunct Meridian Stud 2021; 14:89-94. [DOI: 10.51507/j.jams.2021.14.3.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/05/2021] [Accepted: 04/06/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Crischina Branco Marques Sant'Anna
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP) School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Fernanda Pereira de Caxias
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP) School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Paulo Renato Junqueira Zuim
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP) School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Marcella Santos Januzzi
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP) School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Emily Viviane Freitas da Silva
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP) School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Karina Helga Leal Turcio
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP) School of Dentistry, Araçatuba, São Paulo, Brazil
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24
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Sharma S, Ferreira-Valente A, de C Williams AC, Abbott JH, Pais-Ribeiro J, Jensen MP. Group Differences Between Countries and Between Languages in Pain-Related Beliefs, Coping, and Catastrophizing in Chronic Pain: A Systematic Review. PAIN MEDICINE 2021; 21:1847-1862. [PMID: 32044980 PMCID: PMC7553014 DOI: 10.1093/pm/pnz373] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy. Design Systematic review. Methods Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20–0.49), medium (0.50–0.79), or large (≥0.80). Results We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate. Conclusions In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.
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Affiliation(s)
- Saurab Sharma
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - José Pais-Ribeiro
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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25
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Figge CJ, Martinez-Torteya C, Bogat GA, Levendosky AA. Child Appraisals of Interparental Conflict: The Effects of Intimate Partner Violence and Parent-Child Relationship Quality. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP4919-NP4940. [PMID: 30156952 DOI: 10.1177/0886260518794509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Children's appraisals of interparental violence, including appraisals of high threat and low coping efficacy, are robust predictors of behavioral and emotional problems. However, few studies have examined the factors that account for children's use of these maladaptive appraisals, particularly among children exposed to more severe forms of interparental conflict. The current study examines parent-child relationship quality as a mediator of the effect of intimate partner violence (IPV) exposure on children's appraisals of conflict. Participants were 118 mother-child dyads (54 girls and 64 boys), recruited from three Midwestern counties. Consistent with previous reports, child exposure to IPV, as reported by children's mothers, predicted higher threat and lower coping efficacy appraisals. In addition, mediation analyses showed child reports of parent-child relationship quality mediated the association between IPV and coping efficacy, but not the effects of IPV on threat appraisals. The role of parent-child relationships in shaping cognitive appraisals in the context of IPV exposure can have implications for prevention and intervention efforts as well as public policy.
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26
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Li Y(C, Hapidou EG. Patient Satisfaction With Chronic Pain Management: Patient Perspectives of Improvement. J Patient Exp 2021; 8:23743735211007834. [PMID: 34179424 PMCID: PMC8205408 DOI: 10.1177/23743735211007834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Integrating satisfaction measures with pain-related variables can highlight global change and improvement from the patients' perspective. This study examined patient satisfaction in an interdisciplinary chronic pain management program. Nine hundred and twenty-seven (n = 927) participants completed pre- and post-treatment measures of pain, depression, catastrophizing, anxiety, stages of change, and pain acceptance. Multiple regression was used to examine these variables at admission and discharge as predictors of patient satisfaction. Pain-related variables explained 50.6% of the variance (R2 = .506, F 22,639 = 29.79, P < .001) for general satisfaction, and 38.9% of the variance (R2 = 0.389, F 22,639 = 18.49, P < .001) for goal accomplishment. Significant predictors of general satisfaction included depression (β = -0.188, P < .001) and the maintenance stage of change (β = 0.272, P < .001). The latter was also a significant predictor of goal accomplishment (β = 0.300, P < .001). Discharge pain-related measures are more influential than admission measures for predicting patient satisfaction. Patient satisfaction is significantly related to establishing a self-management approach to pain.
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Affiliation(s)
- Yuelin (Cindy) Li
- Department of Psychology, Neuroscience and Behaviour (PNB), 3710McMaster University, Hamilton, Ontario, Canada
| | - Eleni G Hapidou
- Department of Psychology, Neuroscience and Behaviour (PNB), 3710McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Bachelor of Health Sciences (Honour’s) Program, McMaster University, Hamilton, Ontario, Canada
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27
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Areerak K, Waongenngarm P, Janwantanakul P. Factors associated with exercise adherence to prevent or treat neck and low back pain: A systematic review. Musculoskelet Sci Pract 2021; 52:102333. [PMID: 33529988 DOI: 10.1016/j.msksp.2021.102333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Much attention has been paid to the evaluation of the efficacy of exercise therapy or increasing physical activity with the aim to prevent or alleviate neck and low back pain. However, exercise adherence is necessary for the effective management of neck and low back pain. OBJECTIVE We aimed to systematically review randomized controlled trials and cohort studies to gain insights into the factors associated with adherence to exercise or physical activity programs to prevent or treat neck pain and low back pain. METHOD Publications were systematically searched from 1980-December 2019 in several databases. The following key words were used: neck pain or low back pain paired with exercise or physical activity and adherence or compliance. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. Quality of evidence was assessed and rated according to GRADE guidelines. RESULTS Nine randomized controlled trials and eight cohort studies were included in this review. Randomized controlled trials indicated moderate-quality evidence for the association between exercise adherence and self-efficacy. Cohort studies showed moderate-quality evidence for the association between exercise adherence and education level. CONCLUSIONS Literature investigating factors associated with exercise adherence to prevent or treat neck and low back pain was heterogeneous. Few factors were found to be associated with exercise adherence. More studies are needed before any firm conclusions can be reached.
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Affiliation(s)
- Kantheera Areerak
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
| | - Pooriput Waongenngarm
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
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28
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Kazi A, West E, Rahman S, Kim S, Sima A, Schuman TA. Pain Catastrophizing and Quality of Life in Adults With Chronic Rhinosinusitis. Laryngoscope 2021; 131:1939-1945. [PMID: 33513282 DOI: 10.1002/lary.29405] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Psychological comorbidity is common in patients with chronic rhinosinusitis (CRS) and is correlated with decreased overall and disease-specific quality of life (QoL). Prior research reported that anxiety and depression, as measured by the hospital anxiety and depression scale (HADS), are associated with worse CRS-specific QoL, as assessed via the Rhinosinusitis Disability Index (RSDI). Furthermore, patients prone to anxiety/depression may display an exaggerated response to real or anticipated discomfort; the pain catastrophizing scale (PCS) is a validated instrument designed to measure this phenomenon. This study is intended to explore the role of pain catastrophizing in relation to anxiety, depression, and disease-specific QoL in patients with facial pain attributed to CRS. STUDY DESIGN Prospective cohort study. METHODS Diagnosis of presumed CRS was based upon current American Academy of Otolaryngology - Head & Neck Surgery (AAO-HNS) guidelines; all participants reported facial pain as a component of their CRS symptomatology. RSDI, HADS, and PCS questionnaires were administered upon presentation prior to intervention, and objective measurements of sinonasal inflammation were obtained via nasal endoscopy and computed tomography (CT). RESULTS Seventy-five patients were enrolled in the study. Significant positive correlations were found between PCS and HADS, total RSDI, and RSDI emotional sub-scores (P < .05). The incidence of objective evidence of disease, as measured via nasal endoscopy and CT, was not significantly different in catastrophizing patients. CONCLUSIONS Pain catastrophizing correlates with anxiety/depression and worse disease-specific QoL in patients meeting symptomatic criteria for CRS. Otolaryngologists should be aware that catastrophic thinking can intensify a patient's perception of sinonasal symptoms, and clinicians may consider management of psychological comorbidity to optimize rhinologic outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1939-1945, 2021.
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Affiliation(s)
- Aasif Kazi
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Emma West
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Shahryar Rahman
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Sarah Kim
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Theodore A Schuman
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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29
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Gilliam WP, Schumann ME, Cunningham JL, Evans MM, Luedtke CA, Morrison EJ, Sperry JA, Vowles KE. Pain catastrophizing as a treatment process variable in cognitive behavioural therapy for adults with chronic pain. Eur J Pain 2020; 25:339-347. [PMID: 33030769 DOI: 10.1002/ejp.1671] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interdisciplinary cognitive behavioural therapy (CBT) for chronic pain is effective at improving function, mood and pain interference among individuals with disabling chronic pain. Traditionally, CBT assumes that cognitive change is an active therapeutic ingredient in the determination of treatment outcome. Pain catastrophizing, a cognitive response style that views the experience of pain as uncontrollable, permanent and destructive, has been identified as an important maladaptive cognition which contributes to difficulties with the management of chronic pain. Consequently, pain catastrophizing is commonly targeted in CBT for chronic pain. OBJECTIVES To examine change trajectories in pain catastrophizing during treatment and assess the relevance of these trajectories to outcomes at posttreatment. METHODS Participants included individuals with chronic pain (N = 463) who completed a 3-week program of interdisciplinary CBT. Pain catastrophizing was assessed weekly over the 3 weeks of treatment and latent growth curve modelling was used to identify trajectories of change. RESULTS Findings indicated the presence of two classes of linear change, one with a significant negative slope in pain catastrophizing (i.e. improved class) and the other with a non-significant slope (i.e. unchanged class). Next, latent growth mixture modelling examined treatment outcome in relation to class membership. These results indicated that individuals in the 'improved' PCS class had significantly greater improvement in pain interference and mood, as well as physical and mental quality of life compared to the 'unchanged' class. CONCLUSIONS Implications for our findings, in relation to the CBT model, are discussed.
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Affiliation(s)
- Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Matthew E Schumann
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Julie L Cunningham
- Department of Pharmacy, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michele M Evans
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Connie A Luedtke
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jeannie A Sperry
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, UK
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30
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Han X, Geffen S, Browning M, Kenardy J, Geffen G. Outcome evaluation of a multidisciplinary pain management programme comparing group with individual change measures. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2011.00032.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Xiuwen Han
- RehabMX, Woolloongabba
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Saul Geffen
- RehabMX, Woolloongabba
- Canossa Hospital, Oxley
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | | | - Justin Kenardy
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Gina Geffen
- RehabMX, Woolloongabba
- Canossa Hospital, Oxley
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
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31
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Hybrid System of Emotion Evaluation in Physiotherapeutic Procedures. SENSORS 2020; 20:s20216343. [PMID: 33172146 PMCID: PMC7664429 DOI: 10.3390/s20216343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
Nowadays, the dynamic development of technology allows for the design of systems based on various information sources and their integration into hybrid expert systems. One of the areas of research where such systems are especially helpful is emotion analysis. The sympathetic nervous system controls emotions, while its function is directly reflected by the electrodermal activity (EDA) signal. The presented study aimed to develop a tool and propose a physiological data set to complement the psychological data. The study group consisted of 41 students aged from 19 to 26 years. The presented research protocol was based on the acquisition of the electrodermal activity signal using the Empatica E4 device during three exercises performed in a prototype Disc4Spine system and using the psychological research methods. Different methods (hierarchical and non-hierarchical) of subsequent data clustering and optimisation in the context of emotions experienced were analysed. The best results were obtained for the k-means classifier during Exercise 3 (80.49%) and for the combination of the EDA signal with negative emotions (80.48%). A comparison of accuracy of the k-means classification with the independent division made by a psychologist revealed again the best results for negative emotions (78.05%).
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32
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Herman PM, Edelen MO, Rodriguez A, Hilton LG, Hays RD. A protocol for chronic pain outcome measurement enhancement by linking PROMIS-29 scale to legacy measures and improving chronic pain stratification. BMC Musculoskelet Disord 2020; 21:671. [PMID: 33038933 PMCID: PMC7547501 DOI: 10.1186/s12891-020-03696-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/01/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Substantial investment has gone into research on the efficacy and effectiveness of pharmaceutical and nonpharmacologic interventions for chronic pain. However, synthesizing this extensive literature is challenging because of differences in the outcome measures used in studies of similar or competing interventions. The absence of a common metric makes it difficult to replicate findings, pool data from multiple studies, resolve conflicting conclusions, or reach consensus when interpreting findings. METHODS This study has a seven-member Advisory Council of chronic pain experts. Preliminary analyses will be performed on data from several large existing datasets; intermediate analyses will be performed using primary data collected from Amazon's Mechanical Turk (MTurk); and cross-validation will use primary data collected from a nationally-representative, probability-based panel. Target sample size for both primary datasets is 1500. The three study aims are as follows: Aim 1 will develop and evaluate links between the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS®-29) and legacy measures used for chronic pain such as the Roland-Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI). We will assess the best method of score linking and create crosswalk tables. Aim 2 will evaluate and refine the Impact Stratification Score (ISS) based on 9 PROMIS-29 items and proposed by the NIH Research Task Force on chronic low back pain. We will evaluate the ISS in terms of other indicators of condition severity and patient prognosis and outcomes and identify cut-points to stratify chronic pain patients into subgroups. Aim 3 will evaluate the strengths and limitations of MTurk as a data collection platform for estimating chronic pain by comparing its data to other data sources. DISCUSSION The accomplishment of Aims 1 and 2 will allow direct comparison of results across past and future studies of chronic pain. These comparisons will help us to understand different results from seemingly similar studies, and to determine the relative effectiveness of all pharmaceutical and nonpharmacologic interventions for chronic pain across different trials. Aim 3 findings will provide valuable information to researchers about the pros and cons of using the MTurk platform for research-based data collection. TRIAL REGISTRATION ClinicalTrials.gov: NCT04426812 ; June 10, 2020.
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Affiliation(s)
| | | | | | - Lara G Hilton
- Government & Public Services, Deloitte Consulting, LLP, Los Angeles, CA, USA
| | - Ron D Hays
- RAND Corporation, Santa Monica, CA, USA
- Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA
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33
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Toledo TA, Kuhn BL, Payne MF, Lannon EW, Palit S, Sturycz CA, Hellman N, Güereca YM, Demuth MJ, Huber F, Shadlow JO, Rhudy JL. The Effect of Pain Catastrophizing on Endogenous Inhibition of Pain and Spinal Nociception in Native Americans: Results From the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2020; 54:575-594. [PMID: 32073117 PMCID: PMC7414293 DOI: 10.1093/abm/kaaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Conditioned pain modulation (CPM) is a task that involves measuring pain in response to a test stimulus before and during a painful conditioning stimulus (CS). The CS pain typically inhibits pain elicited by the test stimulus; thus, this task is used to assess endogenous pain inhibition. Moreover, less efficient CPM-related inhibition is associated with chronic pain risk. Pain catastrophizing is a cognitive-emotional process associated with negative pain sequelae, and some studies have found that catastrophizing reduces CPM efficiency. PURPOSE The current study examined the relationship between catastrophizing (dispositional and situation specific) and CPM-related inhibition of pain and the nociceptive flexion reflex (NFR; a marker of spinal nociception) to determine whether the catastrophizing-CPM relationship might contribute to the higher risk of chronic pain in Native Americans (NAs). METHODS CPM of pain and NFR was assessed in 124 NAs and 129 non-Hispanic Whites. Dispositional catastrophizing was assessed at the beginning of the test day, whereas situation-specific catastrophizing was assessed in response to the CS, as well as painful electric stimuli. RESULTS Situation-specific, but not dispositional, catastrophizing led to less NFR inhibition but more pain inhibition. These effects were not moderated by race, but mediation analyses found that: (a) the NA race was associated with greater situation-specific catastrophizing, which led to less NFR inhibition and more pain inhibition, and (b) situation-specific catastrophizing was associated with greater CS pain, which led to more pain inhibition. CONCLUSIONS Catastrophizing may contribute to NA pain risk by disrupting descending inhibition.
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Affiliation(s)
- Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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Nawai A, Foust JB, Shi L, You T, Leveille SG. Is pain catastrophizing associated with poor mobility performance and falls in older adults? Arch Gerontol Geriatr 2020; 91:104219. [PMID: 32771882 PMCID: PMC9124526 DOI: 10.1016/j.archger.2020.104219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pain catastrophizing has been associated with pain intensity and mobility limitations in adults, and may be associated with mobility problems among older adults with chronic pain. This study examined the associations between pain catastrophizing and pain characteristics, and physical performance in older people. METHODS The MOBILIZE Boston Study II (MBS) included 354 adults aged ≥70 years, living in the Boston area, originally enrolled in the MBS I from 2005-2008. Pain catastrophizing was measured using the 13-item Pain Catastrophizing Scale (PCS), with scores ranging from 13-65. Pain severity and pain interference were assessed by subscales of the Brief Pain Inventory. Pain distribution was classified as none, single site, and multisite. Mobility performance was assessed using the Short Physical Performance Battery (SPPB). Falls were assessed prospectively using monthly fall calendar postcards. RESULTS One-fourth of all participants (24 %) had high scores on the PCS (score>30). PCS was inversely associated with age and was greater among those with osteoarthritis, depression, or anxiety (p-value<0.05). PCS score was associated with global measures of pain including pain severity (p-value = 0.01), pain interference (p-value = 0.004) and multisite pain compared to no pain (p-value = 0.006). After adjusting for confounders, PCS was not associated with mobility and fall in this older population. CONCLUSION Although pain catastrophizing is prevalent in older adults with chronic pain, it was not associated with mobility or falls in older people. Further research is needed to determine possible long-term effects of pain catastrophizing on chronic pain and functioning in older adults.
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Affiliation(s)
- Ampicha Nawai
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Boromarajonani College of Nursing, Chiang Mai, Thailand.
| | - Janice B Foust
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Tongjian You
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Åkerblom S, Perrin S, Rivano Fischer M, McCracken LM. Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: the contributions of psychological flexibility. J Behav Med 2020; 44:111-122. [PMID: 32642875 PMCID: PMC7846536 DOI: 10.1007/s10865-020-00168-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/19/2020] [Indexed: 11/26/2022]
Abstract
There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain outcomes. The first aim of this study was to assess whether pre-treatment scores on measures of psychological (in)flexibility, acceptance, committed action, cognitive (de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological flexibility measures, only pre-treatment scores on the psychological inflexibility scale predicted outcomes; higher scores on this measure were associated with worse outcomes. However, change scores on each of the psychological flexibility measures separately mediated outcomes. The efficacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychological flexibility.
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Affiliation(s)
- Sophia Åkerblom
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Marcelo Rivano Fischer
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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Day MA, Ehde DM, Burns J, Ward LC, Friedly JL, Thorn BE, Ciol MA, Mendoza E, Chan JF, Battalio S, Borckardt J, Jensen MP. A randomized trial to examine the mechanisms of cognitive, behavioral and mindfulness-based psychosocial treatments for chronic pain: Study protocol. Contemp Clin Trials 2020; 93:106000. [PMID: 32302791 PMCID: PMC7195020 DOI: 10.1016/j.cct.2020.106000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
This randomized trial will evaluate the mechanisms of three chronic pain treatments: cognitive therapy (CT), mindfulness meditation (MM), and activation skills (AS). We will determine the extent to which late-treatment improvement in primary outcome (pain interference) is predicted by early-treatment changes in cognitive content, cognitive process, and/or activity level. The shared versus specific role of these mechanisms across the three treatments will be evaluated during treatment (Primary Aim), and immediately post-treatment to examine relapse mechanisms (Secondary Aim). We will enroll 300 individuals with chronic pain (with low back pain as a primary or secondary condition), with 240 projected to complete the study. Participants will be randomly assigned to eight, 1.5 h telehealth group sessions of CT, MM, or AS. Mechanisms and outcomes will be assessed twice daily during 2-week baseline, 4-week treatment period, and 4-week post-treatment epoch via random cue-elicited ecological momentary assessment (EMA); activity level will be monitored during these time epochs via daily monitoring with ActiGraph technology. The primary outcome will be measured by the PROMIS 5-item Pain Interference scale. Structural equation modeling (SEM) will be used to test the primary aims. This study is pre-registered on clinicaltrials.gov (Identifier: NCT03687762). This study will determine the temporal sequence of lagged mediation effects to evaluate rates of change in outcome as a function of change in mediators. The findings will provide an empirical basis for enhancing and streamlining psychosocial chronic pain interventions. Further, results will guide future efforts towards optimizing maintenance of gains to effectively reduce relapse risk.
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Affiliation(s)
- M A Day
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia.
| | - D M Ehde
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J Burns
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - L C Ward
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J L Friedly
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - B E Thorn
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - M A Ciol
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - E Mendoza
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J F Chan
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - S Battalio
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J Borckardt
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - M P Jensen
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
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Rhudy JL, Arnau RC, Huber FA, Lannon EW, Kuhn BL, Palit S, Payne MF, Sturycz CA, Hellman N, Guereca YM, Toledo TA, Shadlow JO. Examining Configural, Metric, and Scalar Invariance of the Pain Catastrophizing Scale in Native American and Non-Hispanic White Adults in the Oklahoma Study of Native American Pain Risk (OK-SNAP). J Pain Res 2020; 13:961-969. [PMID: 32440202 PMCID: PMC7221415 DOI: 10.2147/jpr.s242126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Native Americans (NAs) have a higher prevalence of chronic pain than other US racial/ethnic groups, but the mechanisms contributing to this pain disparity are under-researched. Pain catastrophizing is one of the most important psychosocial predictors of negative pain outcomes, and the Pain Catastrophizing Scale (PCS) has been established as a reliable and valid measure of the pain catastrophizing construct. However, before the PCS can be used to study pain risk in NAs, it is prudent to first determine whether the established 3-factor structure of the PCS also holds true for NAs. METHODS The current study examined the measurement (configural, metric, and scalar) invariance of the PCS in a healthy, pain-free sample of 138 NA and 144 non-Hispanic white (NHW) participants. RESULTS Results suggest that the previously established 3-factor solution fits for both groups (configural invariance) and that the factor loadings were equivalent across groups (metric invariance). Scalar invariance was also established, except for 1 minor scalar difference in a single threshold for item 3 (suggesting NHWs were more likely to respond with a 4 on that item than NAs). DISCUSSION Results provide additional evidence for the psychometric properties of the PCS and suggest it can be used to study pain catastrophizing in healthy, pain-free NA samples.
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Affiliation(s)
- Jamie L Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Randolph C Arnau
- University of Southern Mississippi, Department of Psychology, Hattiesburg, MS, USA
| | | | - Edward W Lannon
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Bethany L Kuhn
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Shreela Palit
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Michael F Payne
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Natalie Hellman
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Yvette M Guereca
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Tyler A Toledo
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
| | - Joanna O Shadlow
- The University of Tulsa, Department of Psychology, Tulsa, OK, USA
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Mun CJ, Davis MC, Campbell CM, Finan PH, Tennen H. Linking Nonrestorative Sleep and Activity Interference Through Pain Catastrophizing and Pain Severity: An Intraday Process Model Among Individuals With Fibromyalgia. THE JOURNAL OF PAIN 2020; 21:546-556. [PMID: 31526852 PMCID: PMC7069767 DOI: 10.1016/j.jpain.2019.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/12/2019] [Accepted: 09/12/2019] [Indexed: 12/29/2022]
Abstract
Nonrestorative sleep is a key diagnostic feature of the musculoskeletal pain disorder fibromyalgia and is robustly associated with poor physical functioning, including activity interference. However, the mechanisms through which nonrestorative sleep elicits activity interference among individuals with fibromyalgia at the within-person level remain unclear. The present study tested the following 3-path mediation model, using data gathered from a 21-day electronic daily diary in 220 individuals with fibromyalgia: previous night nonrestorative sleep → morning pain catastrophizing → afternoon pain severity → end-of-day activity interference. Results of multilevel structural equation modeling supported the 3-path mediation model. Previous night's nonrestorative sleep and morning pain catastrophizing were also directly related to end-of-day activity interference. Previous night nonrestorative sleep did not significantly predict afternoon pain severity while controlling for the effect of morning pain catastrophizing. Greater nonrestorative sleep during the previous night and a higher level of morning pain catastrophizing appear to serve as risk factors for experiencing greater daily pain and activity interference later in the day. These findings point to the potential utility of targeted interventions that improve both sleep quality and pain catastrophizing to help individuals with chronic pain engage in important daily activities despite experiencing pain. PERSPECTIVE: This study provides a better understanding of how nonrestorative sleep is associated with daily activity interference among individuals with fibromyalgia. An intervention that targets attenuating nonrestorative sleep and pain catastrophizing may help improve daily physical functioning of this population.
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Affiliation(s)
- Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Mary C Davis
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Howard Tennen
- Department of Community Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
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Crombez G, De Paepe AL, Veirman E, Eccleston C, Verleysen G, Van Ryckeghem DM. Let's talk about pain catastrophizing measures: an item content analysis. PeerJ 2020; 8:e8643. [PMID: 32181053 PMCID: PMC7060750 DOI: 10.7717/peerj.8643] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Concerns have been raised about whether self-report measures of pain catastrophizing reflect the construct as defined in the cognitive-behavioral literature. We investigated the content of these self-report measures; that is, whether items assess the construct 'pain catastrophizing' and not other theoretical constructs (i.e., related constructs or pain outcomes) using the discriminant content validity method. METHOD Items (n = 58) of six pain catastrophizing measures were complemented with items (n = 34) from questionnaires measuring pain-related worrying, vigilance, pain severity, distress, and disability. Via an online survey, 94 participants rated to what extent each item was relevant for assessing pain catastrophizing, defined as "to view or present pain or pain-related problems as considerably worse than they actually are" and other relevant constructs (pain-related worrying, vigilance, pain severity, distress, and disability). RESULTS Data were analyzed using Bayesian hierarchical models. The results revealed that the items from pain-related worrying, vigilance, pain severity, distress, and disability questionnaires were distinctively related to their respective constructs. This was not observed for the items from the pain catastrophizing questionnaires. The content of the pain catastrophizing measures was equally well, or even better, captured by pain-related worrying or pain-related distress. CONCLUSION Based upon current findings, a recommendation may be to develop a novel pain catastrophizing questionnaire. However, we argue that pain catastrophizing cannot be assessed by self-report questionnaires. Pain catastrophizing requires contextual information, and expert judgment, which cannot be provided by self-report questionnaires. We argue for a person-centered approach, and propose to rename 'pain catastrophizing' measures in line with what is better measured: 'pain-related worrying'.
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Affiliation(s)
- Geert Crombez
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Annick L. De Paepe
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Elke Veirman
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | | | - Gregory Verleysen
- Ghent University, Research Support Office, Faculty of Psychology and Educational Sciences, Ghent, Belgium
| | - Dimitri M.L. Van Ryckeghem
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Institute for Health and Behaviour, INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Kim S, Whibley D, Williams DA, Kratz AL. Pain Acceptance in People With Chronic Pain and Spinal Cord Injury: Daily Fluctuation and Impacts on Physical and Psychosocial Functioning. THE JOURNAL OF PAIN 2020; 21:455-466. [DOI: 10.1016/j.jpain.2019.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/15/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
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Variation in Offer of Operative Treatment to Patients With Trapeziometacarpal Osteoarthritis. J Hand Surg Am 2020; 45:123-130.e1. [PMID: 31859053 DOI: 10.1016/j.jhsa.2019.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/09/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Operative treatment of trapeziometacarpal osteoarthritis (TMC OA) is discretionary. There is substantial surgeon-to-surgeon variation in offers of surgery. This study assessed factors associated with variation in recommendation of operative treatment to patients with TMC OA. Secondarily, we studied factors associated with preferred operative technique and surgeon demographic factors variability in recommendation for operative treatment. METHODS We invited all hand surgeon members of the Science of Variation Group to review 16 scenarios of patients with TMC OA and asked the surgeons whether they would recommend surgical treatment for each patient and, if yes, which surgical technique they would offer (trapeziectomy, trapeziectomy with ligament reconstruction and/or tendon interposition, joint replacement, or arthrodesis). Scenarios varied in pain intensity, relief after injection, radiographic severity, and psychosocial symptoms. RESULTS Patient characteristics associated with greater likelihood to recommend surgical treatment were substantial pain, a previous injection that did not relieve pain, radiograph with severe TMC OA, and few symptoms of depression. Practice region was the only factor associated with preferred surgical technique and trapeziectomy with ligament reconstruction and/or tendon interposition the most commonly recommended treatment. There was low agreement among surgeons regarding treatment recommendations. CONCLUSIONS The notable variation in offers of operative treatment for TMC OA is largely associated with variable attention to subjective factors. Future studies might address the relative influence of surgeon incentives and beliefs, objective pathophysiology, and subjective patient factors on variation in surgeon recommendations. CLINICAL RELEVANCE Surgeons' awareness of the potential influence of subjective factors on their recommendations might contribute to efforts to ensure that patient choices reflect what matters most to them and are not based on misconceptions.
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Clinical and Demographic Predictors of Interdisciplinary Chronic Pain Rehabilitation Program Treatment Response. THE JOURNAL OF PAIN 2019; 20:1470-1485. [DOI: 10.1016/j.jpain.2019.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/24/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
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Zheng K, Wang X. Publications on the Association Between Cognitive Function and Pain from 2000 to 2018: A Bibliometric Analysis Using CiteSpace. Med Sci Monit 2019; 25:8940-8951. [PMID: 31762442 PMCID: PMC6894366 DOI: 10.12659/msm.917742] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aimed to use CiteSpace software to conduct a bibliometric analysis of published studies on the association between pain and cognitive function from 2000 to 2018. The study also aimed to determine publication patterns and authorship and to identify recent trends for research in this field. MATERIAL AND METHODS Publications on the association between cognitive function and pain between 2000 and 2018 were identified from the Web of Science database. Bibliographic information, including authorship, country, citation frequency, changes in citation, and interactive visualization were generated using CiteSpace software. Co-citation, or frequency of two publications cited together by another publication, was also studied. RESULTS On 8th January 2019, 4,889 publications were identified. The United States (1132 publications) and the University of Washington (87 publications) were the most productive country and institution, respectively. The journal, Pain (182 publications) had the largest number of publications and was the most frequently cited journal (citation counts, 1569) with the highest centrality (0.62). Author A had the largest number of publications (21). Author B had the greatest co-citation count (223). Author C tied with Author D as the first co-cited author in terms of centrality (0.18). Author E in 2011 (co-citation count, 96) and Author F in 2008 (centrality: 0.11) had the highest co-citation counts and centrality, respectively. The keyword 'empathy' ranked first for research developments with the highest citation burst (10.045). CONCLUSIONS Bibliometric analysis of the association between pain and cognitive function might identify new directions for future research.
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Affiliation(s)
- Kangyong Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,The Fifth Clinical College, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China (mainland)
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Khampanthip A, Kanlayanaphotporn R, Jensen MP, Janwantanakul P. Cross-cultural adaptation, test-retest reliability, and construct validity of the Thai version of the University of Washington Pain-Related Self-Efficacy Scale. Pain Rep 2019; 4:e787. [PMID: 31984292 PMCID: PMC6903351 DOI: 10.1097/pr9.0000000000000787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/08/2019] [Accepted: 08/01/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION One psychosocial factor in the biopsychosocial model is pain-related self-efficacy, which has been shown to be a strong predictor of response to pain treatment. OBJECTIVES To cross-culturally adapt the University of Washington Pain-Related Self-Efficacy Scale (UW-PRSE6) into Thai and evaluate its psychometric properties. METHODS The study was approved by the Chulalongkorn University Human Ethics Committee (COA No. 156/2018). The original UW-PRSE6 was cross-culturally adapted using the Functional Assessment of Chronic Illness Therapy translation methodology. Two hundred forty-one individuals with chronic low back pain completed the Thai version of UW-PRSE6 (T-UW-PRSE6), Thai Fear Avoidance Beliefs Questionnaire (T-FABQ), and Thai Medical Outcome Study Short-Form 36 (T-SF-36). A subset of 152 participants completed the T-UW-PRSE6 again after a 7-day interval. Cronbach's alpha and intraclass correlation coefficients were calculated to estimate internal consistency and test-retest reliability, respectively. The construct validity of the T-UW-PRSE6 was evaluated by computing Spearman correlation coefficients between the T-UW-PRSE6 score and the measures of the validity criterion variables. RESULTS The T-UW-PRSE6 had good internal consistency (Cronbach's alpha = 0.85) and moderate test-retest reliability (intraclass correlation coefficient [2,1] = 0.72). The T-UW-PRSE6 was negatively correlated with the T-FABQ Work and Physical Activity subscales (rs = -0.34 and -0.34, respectively) and positively correlated with the General Health, Physical Functioning, Role Physical, Role Emotional, Social Functioning, Bodily Pain, Vitality, and Mental Health scales of the T-SF-36 (rs = 0.38, 0.42, 0.54, 0.51, 0.47, 0.54, 0.41, and 0.40, respectively). CONCLUSION The T-UW-PRSE6 demonstrated acceptable psychometric properties for assessing pain-related self-efficacy in individuals with chronic low back pain, making available a measure for facilitating future cross-cultural research on pain self-efficacy.
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Affiliation(s)
- Angkana Khampanthip
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Rotsalai Kanlayanaphotporn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Campos WK, Linhares MN, Sarda J, Santos ARS, Lin K, Latini A, Walz R. Predictors of Pain Recurrence After Lumbar Facet Joint Injections. Front Neurosci 2019; 13:958. [PMID: 31619946 PMCID: PMC6763569 DOI: 10.3389/fnins.2019.00958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction Facet joint injections (FJIs) of anesthetic and corticosteroids are useful for the diagnosis and treatment of low back pain (LBP). In the current study, we evaluated the efficacy of FJI on LBP treatment and the predictive variables of pain recurrence after FJI. Methods We included and followed prospectively forty-three consecutive patients with chronic LBP treated with FJI. Clinical assessments were carried out at a baseline 1 week before FJIs and after a 6-month follow-up visit using the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) for disability-specific measure and MacNab criteria for global effectiveness, and compared through analysis using paired-samples “t” tests. Multiple cox-regression analysis was used to identify the presurgical variables independently associated with pain recurrence anytime during the follow-up. In addition to the demographic, clinical, and surgical data, we also analyzed psychometric scales: Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Results After a 6-month follow-up, thirty-two patients (74.4%) showed a clinically significant reduction of pain and twenty-seven (62.8%) reported a clinically significant improvement of disability. Presurgical catastrophizing (PCS score ≥ 5, adjusted HR 4.4, CI 95% 1.7–11.3, p = 0.002) and smoking (Adjusted HR 12.5, CI 95% 1.1–138.9, p = 0.04) remains associated with pain recurrence. Conclusion FJI reduces LBP and disability of patients with unresponsive LBP. Pain-related cognitive and behavioral factors determined by pain catastrophizing and smoking were independently associated with pain recurrence after lumbar FJI. The results support the need of a multidisciplinary approach for presurgical evaluation of patients with chronic pain.
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Affiliation(s)
- Wuilker Knoner Campos
- Functional Neurosurgery Division, Department of Neurosurgery, Baia Sul Medical Center, Florianópolis, Brazil.,Neuron Institute, Baia Sul Medical Center, Florianópolis, Brazil.,Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, Brazil.,Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Neves Linhares
- Functional Neurosurgery Division, Department of Neurosurgery, Baia Sul Medical Center, Florianópolis, Brazil.,Neuron Institute, Baia Sul Medical Center, Florianópolis, Brazil.,Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, Brazil.,Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Surgery, Neurosurgery Division, HU, UFSC, Florianópolis, Brazil
| | - Jamir Sarda
- Department of Psychology and Master Program of Health and Work, Univali, Itajaí, Brazil
| | | | - Kátia Lin
- Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Internal Medicine, Neurology Division, HU, UFSC, Florianópolis, Brazil
| | - Alexandra Latini
- Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Laboratory of Bioenergetics and Oxidative Stress, Department of Biochemistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Roger Walz
- Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Internal Medicine, Neurology Division, HU, UFSC, Florianópolis, Brazil
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46
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Vega RDL, Miró J, Esteve R, Ramírez-Maestre C, López-Martínez AE, Jensen MP. Sleep disturbance in individuals with physical disabilities and chronic pain: The role of physical, emotional and cognitive factors. Disabil Health J 2019; 12:588-593. [PMID: 31076226 DOI: 10.1016/j.dhjo.2019.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sleep problems are common for individuals living with physical disabilities and chronic pain. However, the factors that influence the relationship between pain and sleep problems in these populations remain unknown. OBJECTIVE The aim of this study was to increase our understanding of the physical, emotional and cognitive factors associated with sleep disturbance in individuals with chronic health conditions often associated with physical disabilities. METHODS Participants were recruited from a database of individuals with a variety of chronic health conditions, including multiple sclerosis, spinal cord injury, back pain, osteoarthritis, and amputations. To participate in the study, they needed to report having a chronic pain problem. Participants completed an online survey using REDCap assessing average pain intensity (Numerical Rating Scale-11), pain extent (number of painful body areas), sleep disturbance (PROMIS Sleep Disturbance), depression (PROMIS Emotional Distress-Depression) and catastrophizing (Coping Strategies Questionnaire). A total of 455 participants (Mage = 58.9; SD = 11.4), of which 292 (64%) were women, provided complete data. We performed a series of four regression analyses. RESULTS After controlling for age and sex, the predictors explained an additional 7-16% of the variance in sleep disturbance. The final model with all of the predictors explained 22%. CONCLUSIONS Consistent with the study hypothesis, all the variables examined made significant and independent contributions to the variance in sleep disturbance. The findings provide additional evidence that physical, emotional and cognitive factors all play a role in the sleep quality of individuals with chronic health conditions often associated with physical disabilities.
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Affiliation(s)
- Rocío de la Vega
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS and Research Center for Behavior Assessment (CRAMC), Department of Psychology and Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
| | | | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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47
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Craner JR, Lake ES, Bancroft KA, George LL. Treatment Outcomes and Mechanisms for an
ACT
‐Based 10‐Week Interdisciplinary Chronic Pain Rehabilitation Program. Pain Pract 2019; 20:44-54. [DOI: 10.1111/papr.12824] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Julia R. Craner
- Mary Free Bed Rehabilitation Hospital Grand Rapids Michigan U.S.A
- Michigan State University College of Human Medicine Grand Rapids Michigan U.S.A
| | - Eric S. Lake
- Mary Free Bed Rehabilitation Hospital Grand Rapids Michigan U.S.A
| | | | - Logan L. George
- Michigan State University College of Human Medicine Grand Rapids Michigan U.S.A
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48
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Brain mechanisms impacted by psychological therapies for pain: identifying targets for optimization of treatment effects. Pain Rep 2019; 4:e767. [PMID: 31579858 PMCID: PMC6727993 DOI: 10.1097/pr9.0000000000000767] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/02/2019] [Accepted: 05/25/2019] [Indexed: 12/13/2022] Open
Abstract
Psychological therapies, such as cognitive behavioral therapy, are widely used multifaceted approaches that have been shown to improve pain-related functioning. A small but growing number of studies have used brain imaging to support the use of psychological therapies for pain. Although these studies have led to an increased understanding of how therapies may engage neural systems, there are multiple technical and conceptual challenges to consider. Based on the current literature, several components of effective psychological therapies for pain may be supported by changes in neural circuitry, which are most consistently represented by diminished activation and/or reduced hyperconnectivity in brain regions related to pain processing, emotion, and cognitive control. Findings may vary based on methodological approaches used and may also differ depending on targets of treatment. To provide a nuanced understanding of the current literature, specific targets and components of effective treatments for which a neural basis has been investigated are reviewed. These treatment components include catastrophic thinking about pain, increasing self-efficacy, mindfulness, anxiety symptom reduction, and exposure-based approaches. In general, such strategies have the potential to normalize regional hyperactivations and reduce hyperconnectivity in brain regions associated with nociceptive processing, cognition, and emotion, although additional research is needed. By determining if there are indeed distinct brain mechanisms engaged by different components of psychological therapy and evidence for specific changes in neural function after these interventions, future therapies may be more optimally tailored for individuals afflicted with chronic pain.
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49
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Rhudy JL, Lannon EW, Kuhn BL, Palit S, Payne MF, Sturycz CA, Hellman N, Güereca YM, Toledo TA, Coleman HB, Thompson KA, Fisher JM, Herbig SP, Barnoski KB, Chee L, Shadlow JO. Sensory, Affective, and Catastrophizing Reactions to Multiple Stimulus Modalities: Results from the Oklahoma Study of Native American Pain Risk. THE JOURNAL OF PAIN 2019; 20:965-979. [PMID: 30797963 PMCID: PMC6689438 DOI: 10.1016/j.jpain.2019.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/31/2019] [Accepted: 02/16/2019] [Indexed: 02/07/2023]
Abstract
Native Americans (NAs) have a higher prevalence of chronic pain than any other U.S. racial/ethnic group; however, little is known about the mechanisms for this pain disparity. This study used quantitative sensory testing to assess pain experience in healthy, pain-free adults (n = 137 NAs (87 female), n = 145 non-Hispanic whites (NHW; 68 female)) after painful electric, heat, cold, ischemic, and pressure stimuli. After each stimulus, ratings of pain intensity, sensory pain, affective pain, pain-related anxiety, and situation-specific pain catastrophizing were assessed. The results suggested that NAs reported greater sensory pain in response to suprathreshold electric and heat stimuli, greater pain-related anxiety to heat and ischemic stimuli, and more catastrophic thoughts in response to electric and heat stimuli. Sex differences were also noted; however, with the exception of catastrophic thoughts to cold, these finding were not moderated by race/ethnicity. Together, findings suggest NAs experience heightened sensory, anxiety, and catastrophizing reactions to painful stimuli. This could place NAs at risk for future chronic pain and could ultimately lead to a vicious cycle that maintains pain (eg, pain → anxiety/catastrophizing → pain). PERSPECTIVE: NAs experienced heightened sensory, anxiety, and catastrophizing reactions in response to multiple pain stimuli. Given the potential for anxiety and catastrophic thoughts to amplify pain, this characteristic may place them at risk for pain disorders and could lead to a vicious cycle that maintains pain.
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Affiliation(s)
- Jamie L Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma.
| | - Edward W Lannon
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Bethany L Kuhn
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Shreela Palit
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma; University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, Seattle, Washington
| | - Michael F Payne
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma; Cincinnati Children's Hospital Medical Center, Department of Anesthesiology, Cincinnati, Ohio
| | | | - Natalie Hellman
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Yvette M Güereca
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Tyler A Toledo
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Heather B Coleman
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma; Northeastern State University, Department of Psychology, Tahlequah, Oklahoma
| | - Kathryn A Thompson
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma; University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
| | - Jessica M Fisher
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Samuel P Herbig
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Ky'Lee B Barnoski
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma; University of Oklahoma-Tulsa, Department of Social Work, Tulsa, OK
| | - Lucinda Chee
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
| | - Joanna O Shadlow
- The University of Tulsa, Department of Psychology, Tulsa, Oklahoma
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50
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O'Loughlin I, Newton-John TRO. 'Dis-comfort eating': An investigation into the use of food as a coping strategy for the management of chronic pain. Appetite 2019; 140:288-297. [PMID: 31145944 DOI: 10.1016/j.appet.2019.05.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/18/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Chronic pain and obesity are major public health concerns. Animal and human models have demonstrated that eating high-sugar nutrient-dense foods confers analgesic effects. Moreover, recent research suggests that people with chronic pain may "comfort eat" to cope with their pain. Given the harmful impact of obesity on chronic pain, it is critical to determine whether pain elicits comfort eating amongst individuals with chronic pain to ensure that this potentially maladaptive pain coping strategy is not overlooked in chronic pain treatment. Therefore, this study aimed to: determine whether chronic pain intensity predicts pain-induced comfort eating and identify mediators of this relationship; to determine whether pain-induced comfort eating predicts elevated BMI; and to establish whether BMI predicts chronic pain interference. METHODS This study utilised a cross-sectional online survey design and a sample of 151 adults with chronic pain. RESULTS Over three-quarters of this chronic pain sample reported engaging in pain-induced comfort eating. Chronic pain intensity did not significantly predict pain-induced comfort eating. However, there was a significant indirect effect of chronic pain intensity on pain-induced comfort eating through stress-but not experiential avoidance or pain catastrophising. As predicted, pain-induced comfort eating significantly predicted increased BMI, and BMI in turn significantly predicted greater chronic pain interference. DISCUSSION This study indicates that pain-induced comfort eating is both common and harmful amongst individuals with chronic pain, across the entire BMI spectrum. Pain-induced comfort eating and stress have emerged as promising chronic pain treatment targets. The findings are discussed and interpreted in light of extant research and theory, as well as limitations of the current study. Future research directions and clinical implications are also considered.
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Affiliation(s)
- Imogen O'Loughlin
- Graduate School of Health, University of Technology Sydney, Australia
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