The relationship of depression and somatic focus to experimental and clinical pain in chronic pain patients

Abstract

The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronic pain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models suggested that depression had a direct influence on the evaluative and affective aspects of pain, but the relationship between depression and sensory pain was mediated by somatic focus. These results provide partial support for Fields' neurobiological model of pain and depression.     

The impact of experiential avoidance on the relations between illness representations,pain catastrophising and pain interference in chronic pain

Objective: The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients’ illness representations to pain interference, through pain catastrophising

Design and main outcome measure: The sample consisted of 162 patients diagnosed with an arthritis-related or a musculoskeletal disorder. The effects of EA on the pathway between illness representations, pain catastrophising and pain interference were examined with PROCESS, a computational tool for SPSS

Results: After controlling for patient and illness-related variables and pain severity, the ‘illness representations–pain catastrophising–pain interference’ pathway was interrupted at the higher levels of EA. The reason was that, at the high levels of EA, either the relation of illness representations to pain catastrophising or the relation of pain catastrophising to pain interference was not statistically significant.

Conclusion: The findings indicate that EA is not a generalised negative response to highly aversive conditions, at least as far as the factors examined in this study are concerned. EA may rather reflect a coping reaction, the impact of which depends on its specific interactions with the other aspects of the self-regulation mechanism. At least in chronic pain, EA should become the focus of potential intervention only when its interaction with the illness-related self-regulation mechanism results in negative outcomes.     

Chronic pelvic pain: A meta-analytic review

Abstract

Chronic pelvic pain (CPP) in women of reproductive age is a common complaint; for many women no identifiable pathology can be found. Research has suggested that women who have chronic pelvic pain without obvious pathology differ on a range of psychological characteristics, such as anxiety and depression, compared with those with identified pathology. A meta-analysis of 22 studies was undertaken to clarify these issues. Results showed that there were no significant differences on a range of psychological variables between women who were identified, via laparoscopy and clinical judgement, as having organic disorders and those who were not so identified. When women with chronic pelvic pain were compared with pain-free groups a profile of elevated depression, anxiety, neuroticism and psychopathology was found which is consistent with findings from studies of other painful conditions.     

Automatic processing of pain: the change of implicit pain associations after psychotherapy

This study explores the utility of a pain IAT for the assessment of dysfunctional cognitive beliefs in chronic pain patients before and after a cognitive behaviour therapy. A patient group suffering from chronic pain (N=25) treated with a 4-week cognitive behavioural psychotherapy is compared with an untreated healthy control group (N=27) at two points in time. In addition, both groups completed a self-esteem questionnaire (Rosenberg-scale) and a self-esteem IAT. In the clinical group a questionnaire assessing self-reported pain cognitions was administered. The pain IAT was able to differentiate between chronic pain patients and healthy controls before the treatment. Most important, pain-related implicit associations could be shown to change over the course of treatment in the clinical group of chronic pain patients. Results provide first evidence for an application of the IAT in chronic pain research.     

Chronic Pain and Neuropsychological Functioning

This review article examines the effect of chronic pain on neuropsychological functioning. Primary attention is given to studies that include patient groups without a history of traumatic brain injury (TBI) or neurologic disorders. Numerous studies were identified that demonstrate neuropsychological impairment in patients with chronic pain, particularly on measures assessing attentional capacity, processing speed, and psychomotor speed. Despite suggestive findings, further studies are needed to clarify the variables that mediate the impact of pain on neuropsychological functioning and the unique role of various symptoms often associated with chronic pain.     

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

Trauma symptoms,temperament traits,social support and the intensity of pain in a Polish sample of patients suffering from chronic pain

The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.     

Sex differences in trauma symptoms,body image and intensity of pain in a Polish sample of patients suffering from chronic pain

The main goal of the current study was to investigate sex differences in the relationship between the level of trauma symptoms appearing in posttraumatic stress disorder (PTSD) and intensity of pain in a sample of 300 Polish patients suffering from chronic pain, specifically rheumatoid arthritis and lower back pain. We also focused on participants’ body image with body esteem as a mediator. To assess the intensity of pain among participants, we used the Numerical Rating Scale. The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory. To measure body image among participants, we used the Body Esteem Scale. The results of our study suggest that trauma symptoms and body image dimensions were significant predictors of pain intensity among men suffering from chronic pain. Moreover, trauma symptoms and age were significant predictors of pain intensity among women suffering from chronic pain. Finally, we demonstrated that sex differentiates the reaction to chronic pain.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

A comparison of pain management outcomes for disability compensation and non-compensation patients

Abstract

In this study, 50 men in an in-patient comprehensive rehabilitation program receiving disability compensation were compared with 25 non-recipients with respect to pre-and post-program measures of personality functioning. physical functioning and reported pain. On the pre-program measures. the only significant difference emerging between the two groups was found on the Mf scale of the MMPI, with the compensation group showing a slightly lower mean score. The two groups responded equally well on virtually all outcome measures. One interesting exception was found on the subjective measure of pain. which showed the compensation group reporting a higher level of subjective pain, and the non-compensation group a lower level than would be predicted on the basis of pre-program scores. Overall. and contrary to popular belief. the results suggest that compensation recipients can derive considerable benefit from pain management interventions despite the ostensible reinforcement provided by disability payments.     

Mediating between international knowledge and local knowledge: The critical role of local field officers in an HIV prevention intervention

The outcomes of health interventions are co‐constructed through negotiation between the competing knowledges of different stakeholders. In such a context, local implementing partners – who mediate between international donors/programme managers and local beneficiary communities – have a critical ‘knowledge brokering’ role to play. With appropriate support, they can facilitate integration of internationally established knowledge with local beliefs and practices in ways that support health‐enhancing behaviour change. This paper focuses on the local field officers of an HIV prevention programme with Cambodian military couples. The paper asks: (1) what are the outcomes of knowledge encounters between international organizations and local field officers, as expressed in field officers' interpretation of programme goals, strategies and messages? (2) To what extent does the intervention context support the field officers' knowledge brokering efforts? Data collected includes semi‐structured interviews, observations of programme meetings and activities, and textual materials. The findings demonstrate that field officers privilege international knowledge, particularly in interactions with international manager–partners. However, in the field, they both hybridize programme messages and struggle to resolve dilemmas provoked by conflicting international and local knowledges. Material and symbolic asymmetries within the intervention context are shown to undermine their knowledge brokering efforts, as field officers attempt to claim identities and futures as health development professionals. Implications for programme practices and accountability systems are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Chronic Pain Syndromes and Violence Against Women

Abstract

Chronic pain is a common form of disability, and is often reported among women with a history of victimization. In the present study, we combine six pain symptoms into a measure of self-reported pain, and compare women who have experienced child or domestic abuse with those who do not report such a history. A sample of 110 female patients (57 abused, 53 non-abused controls) was drawn from an adult primary-care practice of 905 patients in a small, affluent, predominantly Caucasian community in northern New England. The subjects ranged in age from 18 to 88 (M = 47). Subjects completed a self-administered questionnaire that was used clinically as part of the new-patient work-up. Women who reported either child or domestic abuse were significantly more likely to report pain symptoms than women in the control group. There was no significant difference between women who had experienced domestic abuse vs. child abuse alone. These findings held true even after controlling for depression.     

Psychosocial Subgroups, Coping, and Chronic Low-Back Pain

The purpose of this study was to compare psychosocial subgroups in terms of pain coping strategies, pain severity, physical impairment, pain behavior, affective distress, and response to pain management treatment. The Multidimensional Pain Inventory (MPI) was used to classify 67 chronic low-back pain (CLBP) patients into the following psychosocial subgroups: Dysfunctional, Interpersonally Distressed, Adaptive Coping, and Anomalous. These MPI subgroups were compared on the Pain Behavior Checklist, Behavioral Observation Measure of Pain Behavior, Revised Coping Strategies Questionnaire, and Chronic Disease Index. The Dysfunctional subgroup reported significantly more pain behavior, disability, affective distress, and catastrophizing than either the Interpersonally Distressed subgroup or Adaptive Copers, but were not significantly different on measures of adaptive coping strategies. The percentage of dropouts from treatment was significantly less among Adaptive Copers (11%) than among the Dysfunctional (33%) or Interpersonally Distressed (47%) subgroups. Differences in affective distress found among the MPI subgroups at baseline were not evident at the posttreatment assessment. The present findings support the use of MPI psychosocial subgroup analysis to enhance our understanding of differential response to chronic pain and pain management intervention.     

Effects of varied-stimulus exposure on overpredictions of pain and behavioural performance in low back pain patients

The main objective of the present study was to investigate the benefits of exposure to a variety of movements versus exposure to the same movements on overprediction of pain and behavioural performance on a final behavioural test in a sample of chronic low back pain (CLBP) patients. Eighty-four CLBP patients were requested to perform four behavioural tests. Patients were assigned to two experimental conditions. The final behavioural test was the same for all patients. The first three behavioural tests consisted of three different movements in condition 1 and of three times the same movement in condition 2. During each behavioural test, baseline pain, expected pain and experienced pain were recorded. Furthermore, the peak torque and the variability of the produced muscle strength during the final behavioural test were assessed. Replicating and extending previous research, we found that patients overpredicted pain during a threatening behavioural test. Furthermore, pain-related fear and pain catastrophizing showed to be unique predictors of the peak torque of the final behavioural test. No support was found for our hypothesis that varied exposure facilitates generalization of exposure effects. Possible reasons for the failure to find an advantageous effect of varied-stimulus exposure and ideas for future research are discussed.     

Alexithymia and Early Maladaptive Schemas in chronic pain patients

Psychological factors have an impact on subjective pain experience. The aim of this study was to explore the occurrence of alexithymia and Early Maladaptive Schemas in a sample of 271 first visit chronic pain patients of six pain clinics. The patients completed the study questionnaire consisting of the Toronto Alexithymia Scale‐20, the Finnish version of the Young Schema Questionnaire short form‐extended, the Beck Depression Inventory‐II, and pain variables. Alexithymic patients scored higher on Early Maladaptive Schemas and had more pain intensity, pain disability and depression than nonalexithymic patients. Both alexithymia and depression correlated significantly with most Early Maladaptive Schemas. The co‐occurrence of alexithymia, Early Maladaptive Schemas and depression seems to worsen the pain experience. Screening of alexithymia, depression and Early Maladaptive Schemas may help to plan psychological treatment interventions for chronic pain patients.     

Consumer knowledge and use of country‐of‐origin information at the point of purchase

This paper reports an investigation of American and Canadian consumer acquisition and/or knowledge of the country of origin of products at the time of purchase. Consumer knowledge of the country of origin of purchased products was tested as purchasers left the cash register. If the purchaser knew the country of origin of the product just purchased, they were further questioned to discover the role such knowledge might have played in their choice between alternatives. More than 93 per cent of 1,248 purchasers intercepted at the cash register had not acquired while shopping, or did not know from prior experience, the country of origin of a product they had just purchased. Of the 91 (6.5 per cent) who had acquired or knew the country of origin of a product they had just purchased, only 27 (2.2 per cent of the total) indicated that their knowledge of the product's country of origin possibly might have played a role in their product choice. These findings reveal that the country of origin of products is not an important attribute in the choice processes of the great majority of North American consumers. Confirmation of these findings by replication with less obtrusive and more externally valid measures of consumer acquisition and use of product information prior to purchase is needed. Copyright © 2004 Henry Stewart Publications.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase

The concept of acceptance is receiving increased attention as an alternate approach to the suffering that is often associated with persistent and disabling pain. This approach differs from established treatments in that it does not principally focus on reducing pain, but on reducing the distressing and disabling influences of pain as they concern important areas in patients' lives. The present analyses represent a preliminary evaluation of an acceptance-based approach to chronic pain within an interdisciplinary treatment program. One hundred and eight patients with complex chronic pain conditions completed treatment and provided data for the current study. Treatment was conducted in a 3- or 4-week residential or hospital-based format. It included a number of exposure-based, experiential, and other behavior change methods focused on increasing (a) engagement in daily activity regardless of pain and (b) willingness to have pain present without responding to it. Significant improvements in emotional, social, and physical functioning, and healthcare use were demonstrated following treatment. The majority of improvements continued at 3-months post-treatment. Improvements in most outcomes during treatment were correlated with increases in acceptance, supporting the proposed process of treatment.