Quality of Life in Patients with Chronic Pain- A Study in Indian Population Using European Organization for Research and Treatment of Cancer(EORTC) Questionnaire

Quality of life in chronic pain Health-related quality of life was compared in patients of chronic pain with that of general population.We designed this study as a prospective, observational trial in a tertiary care centre. Quality of life was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The EORTC QLQ-C30 is a valid alternative to the SF-36 in the assessment of QOL in patients with chronic pain especially when a broader assessment of symptoms is desired. All participants completed a set of questionnaires on demographic variables, cause, pain intensity (VAS) and quality of life (EORTC qlq c30). A total of two hundred participants were enrolled including 100 patients with chronic pain. Chronic pain was defined as one which is persisting beyond 3 months. The study revealed significantly decreased quality of life in patients with chronic pain as compared to general population (p?<?0.001). Patients with chronic pain had significantly decreased score in Physical functioning, Role functioning, emotional and social functioning on functional scales and increased scores of pain, fatigue, sleep disturbances and financial difficulties on symptom scales. The study revealed sex-related differences on the QoL with females having a lower global QOL. It is thus concluded that patients with chronic pain especially females have decreased quality of life as compared to general population     

Pain anxiety, acceptance, and outcomes among individuals with HIV and chronic pain: a preliminary investigation

The current study investigated the role of during treatment changes in pain anxiety in the relation between during treatment changes in pain acceptance and chronic pain outcomes. Participants included 45 (15 women) adults (M_age = 50.42, SD = 7.69) who were HIV positive and experienced chronic pain. They were offered 12 weekly, 90-min group CBT sessions to increase understanding about chronic pain and to improve coping skills. Four hierarchical regression analyses were conducted to examine the mediating role of treatment changes in pain anxiety in the relation between treatment changes in pain acceptance and chronic pain outcomes. Results suggest that increases in pain acceptance during treatment were associated with decreased levels of pain anxiety during treatment, as well as decreases in pain-related impairment at treatment completion. Furthermore, decreases in pain anxiety during treatment were associated with decreases in pain-related impairment at treatment completion. Finally, treatment changes in pain anxiety were found to partially mediate the association between treatment changes in pain acceptance and pain-related impairment at treatment completion. Results are discussed within the context of better understanding the processes of change within a CBT model for chronic pain patients.     

Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: A pilot randomised controlled trial

ObjectiveInsomnia is a debilitating comorbidity of chronic pain. This pilot trial tested the utility of a hybrid treatment that simultaneously targets insomnia and pain-related interference.MethodsChronic pain patients with clinical insomnia were randomly allocated to receive 4 weekly 2-h sessions of hybrid treatment (Hybrid Group; n = 10) or to keep a pain and sleep diary for 4 weeks, before receiving the hybrid treatment (Monitoring Group; n = 10). Participants were assessed at the beginning and end of this 4-week period. Primary outcomes were insomnia severity and pain interference. Secondary outcomes were fatigue, anxiety, depression and pain intensity. Ancillary information about the hybrid treatment's effect on psychological processes and sleep (as measured with sleep diary and actigraphy) are also presented, alongside data demonstrating the treatment's clinical significance, acceptability and durability after one and six months. Data from all participants (n = 20) were combined for this purpose.ResultsCompared to symptom monitoring, the hybrid intervention was associated with greater improvement in sleep (as measured with the Insomnia Severity Index and sleep diary) at post-treatment. Although pain intensity did not change, the Hybrid Group reported greater reductions in pain interference, fatigue and depression than the Monitoring Group. Overall, changes associated with the hybrid intervention were clinically significant and durable at 1- and 6-month follow-ups. Participants also rated highly on treatment acceptability.ConclusionThe hybrid intervention appeared to be an effective treatment for chronic pain patients with insomnia. It may be a treatment approach more suited to tackle challenges presented in clinical practice, where problems seldom occur in isolation.     

The Interactive Effects of Chronic Pain, Guilt, and Perfectionism on Work Outcomes

Two studies were conducted examining the interactive effects of chronic pain, perceived perfectionism (e.g., self- and socially prescribed), and guilt on job tension and job satisfaction. It was hypothesized that chronic pain would have its most adverse effects on these work outcomes when concurrently coupled with high levels of perceived perfectionism and guilt. In both studies, the results supported the interaction effect of Chronic Pain × Socially Prescribed Perfectionism × Guilt on tension and satisfaction in the expected direction. As predicted, the results also indicated a Chronic Pain × Guilt × Self-Oriented Perfectionism interaction on job tension. Implications for theory and practice, strengths and limitations, and avenues for future research are provided.     

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.     

Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

IntroductionChronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bi-directional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition.MethodsTwenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition.ResultsThe combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients.DiscussionCBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.     

The Construing Of Pain: A Comparison Of Acute And Chronic Low Back Pain Patients Using The Repertory Grid Technique

Hypotheses derived from the literature on pain and on personal construct theory were tested using the repertory grid technique on samples of acute and chronic low back pain patients. Two main differences emerged between these groups: (a) Chronic pain patients showed a small but significant tendency to associate being in pain with being sensitive to others; and (b) chronic pain patients perceived significantly less anger around them. The two groups were then pooled to examine changes in construing with increasing pain duration. Two main trends were noted with increasing chronicity: (a) Pain patients perceived significantly less depression around them, with the construct depressed/not depressed becoming increasingly subordinate, and (b) pain was seen in increasingly less negative terms. The results are discussed with reference to the literature and suggestions are made for future research areas.     

Worrying about chronic pain: vigilance to threat and misdirected problem solving

Worry is reviewed to inform a cognitive-behavioural understanding of chronic pain. How worry comes to dominate is discussed as 'vigilance' and why worry comes to dominate is discussed as 'problem solving'. These two aspects are applied to worrying about chronic pain. Chronic pain is re-presented as chronic vigilance to threat that may lead to a perservation of attempts at solving the problem of achieving escape from pain. Attempts will be frustrated by the insolubility of the problem of chronic pain. The clinical and theoretical implications of this application are discussed.     

Affective images: relieving chronic pain and enhancing quality of life for older persons.

With increasing life expectancy, the incidence of chronic illness and chronic pain also increase. Chronic pain robs older people of their quality of life, and limits functional mobility and ambulation, which leads to muscle atrophy. Older people are often reluctant to request pain relief, attempting to endure pain as a "normal" part of ageing. Innovative non-pharmacological interventions in pain management are appealing. In this study, affective images and pictures were used in 15 elderly patients (12 female and three male) in chronic pain who needed to perform stretching and standing exercises in their physiotherapy sessions. Pain scores were measured by the Visual Analogue Scale (VAS), and health-related quality of life was measured by the Medical Outcomes Study Short Form 36 (SF-36). VAS and SF-36 were administered in weeks 1 and in 6. Pain scores were measured during physiotherapy session in the following weeks. There was a significant decreased in VAS from week 1 to week 6 (t = 3.607; df = 14; p < 0.05). Also, a significant decrease in VAS occurred when the patients were watching affective pictures while performing the physiotherapy exercise in weeks 2 and 3, but not in weeks 4 and 5. SF-36 increased in week 6, which indicated an increase in health-related quality of life, though not statistically significant. Affective images and pictures appear to be an effective non-pharmacological intervention in pain management for the older person.     

Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review

Background/Objective: To assess the differential efficacy between mindfulness-based interventions and cognitive-behavioral Therapy (CBT) on chronic pain across medical conditions involving pain. Method: ProQuest, Science Direct, Google Scholar, Pubmed, and Embase databases were searched to identify randomized clinical trials. Measurements of mindfulness, pain, mood, and further miscellaneous measurements were included. Results: 18 studies met the inclusion criteria (fibromyalgia, n = 5; low back pain, n = 5; headache/migraine, n = 4; non-specific chronic pain, n = 4). In fibromyalgia, mindfulness based stress reduction (MBSR) was superior to the usual care and Fibroqol, in impact and symptoms. In low back pain, MBSR was superior to the usual care, but not to CBT, in physical functionality and pain intensity. There were no studies on differential efficacy between mindfulness and CBT for headache and non-specific chronic pain, but Mindfulness interventions were superior to the usual care in these syndromes. Conclusions: Mindfulness interventions are superior to usual cares in all diagnoses, but it is not possible to conclude their superiority over CBT. Comparisons between mindfulness interventions are scarce, with MBSR being the most studied. In central sensitization syndromes, variables associated with pain tend to improve with treatment. More research is needed to differentiate diagnosis and intervention.     

When Pain Does Not Heal: The Common Antecedents and Consequences of Chronic Social and Physical Pain

Researchers find that social and physical pain overlap in acute episodes. In this article, we hypothesize that social and physical pain overlap in chronic conditions as well. To support this hypothesis, we reviewed the literature and introduced the Integrated Chronic Pain Model (ICPM), which posits that chronic social and physical pain overlap in their psychological antecedents and consequences. Specifically, the ICPM proposes several common factors that play a role in the onset and maintenance of both social and physical chronic pain and indicates that both forms of pain persistently impair self-regulatory resources and threaten the same basic psychological needs.     

What is chronic pain?

Chronic pain leads to individual suffering and to major costs for all developed countries. Previous studies suggest that both the incidence of disabling chronic pain and the amount of health care consumption due to chronic pain are rapidly increasing. Western medicine is not only often ineffective but may be one of the causes of this epidemic. This article will address the issue of chronic pain of unknown etiology and has the goals of: (1) identifying the factors which have led to our confusion about this topic, and (2) proposing alternative ways of conceptualizing chronic pain and its ensuing behaviors and social consequences. It is concluded that it is essential to discriminate between tissue damage, pain, suffering, pain behaviors, health care consumption, impairment and disability if one is to develop a meaningful conceptualization of the medical, social, economic and political problems of chronic pain. Successful treatment must be defined in behavioral terms such as restoration of normal activities. Disabling chronic pain is often a sign of overwhelming stress engendered by the individual's failure to cope with the demands of industrialized society.     

Acceptance of chronic pain in fibromyalgia patients: adaptation of Chronic Pain Acceptance Questionnaire (CPAQ) in a Spanish population

Acceptance of chronic pain appears as an important factor in the personal ability to restore functioning in the presence of chronic pain. The Chronic Pain Acceptance Questionnaire (CPAQ) is currently the only instrument used to assess the acceptance of pain in people who suffer chronic pain. The revised 20-item version of McCracken and cols. (2004) showed satisfactory psychometric properties. Nevertheless, the CPAQ has not been used in Spain in fibromyalgia patients. The first goal of the study is to examine the Spanish translation of the CPAQ and assess its psychometric properties in a sample of 145 subjects with a diagnosis of fibromyalgia. The second purpose was to analyze the relationships between the CPAQ and other important measures of pain adjustment. Results of exploratory factor analysis indicated that the two-factor model, in a 15-item test, provided a good fit to the data in fibromyalgia patients. Regression analyses showed strong relations with criteria variables (pain intensity, anxiety, depression, etc.) though the subscale Activity Engagement contributed more than Pain Willingness to the prediction of criteria variables.     

Psychological Flexibility,Pain Characteristics and Risk of Opioid Misuse in Noncancerous Chronic Pain Patients

Journal of Clinical Psychology in Medical Settings - Chronic pain has an estimated annual prevalence rate between 10 and 35%. In the US, first-line treatment for chronic pain is often opioids....     

The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Post-Traumatic Stress Disorder Symptoms in United Nations Peacekeepers: An Examination of Factor Structure in Peacekeepers with and without Chronic Pain

Recent factor analytic investigations of post-traumatic stress disorder in military veterans suggest that symptoms are best described by either a hierarchical 2-factor model or a 4-factor inter-correlated model. Other recent evidence suggests that post-traumatic stress disorder and chronic pain are intricately related; however, the nature of this relationship is not well understood. Factor analysis provides one method for clarifying this relationship. In study 1, we compared competing models of post-traumatic stress disorder symptom structure in a sample of 400 male United Nations peacekeepers using confirmatory factor analysis. Results indicated that both the hierarchical 2-factor and the 4-factor inter-correlated models provided good fit to the data. In study 2, the reliability of these models was assessed in 427 male United Nations peacekeepers with chronic back pain and 341 without. Group comparisons of the confirmatory factor analysis results revealed that the structure of the hierarchical 2-factor and 4-factor inter-correlated models both provided good fit to the data in both the chronic back pain and the group without. However, the structure of the models for the group with chronic back pain group differed in significant ways from that of the group without chronic back pain. Post-traumatic stress disorder symptoms in military veterans can be adequately conceptualized using either a hierarchical 2-factor or 4-factor inter-correlated model. Chronic pain has a minimal influence on overall factor structure. The hierarchical 2-factor model, while parsimonious, does not provide the degree of symptom detail provided by the 4-factor inter-correlated model. Implications for conceptualization of post-traumatic stress disorder symptoms for patients with chronic back pain and significant post-traumatic stress disorder symptomatology are discussed.     

Influence of Religiosity on the Quality of Life and on Pain Intensity in Chronic Pancreatitis Patients After Neurolytic Celiac Plexus Block: Case-Controlled Study

The quality of life in patients with chronic pancreatitis (CP) is reduced due to their suffering of high levels of pain. It has been presented that quality of life can also be linked to religiosity and/or spirituality. The aim of this study is to assess the influence of religious practices on the quality of life and on the subjective level of pain in CP patients. Ninety-two patients (37 women and 55 men) with chronic pancreatitis were treated invasively for pain with neurolytic celiac plexus block (NCPB). The religiosity of the patients was recorded and served as a dichotomizer. Group 1 was for patients who claimed to have no contact with the church or to have very sporadic contact (N = 35 patients). Group 2 was for patients who claimed to have deep faith and were regular participants at church activities (N = 57 patients). Visual analogue scale was used to assess pain, while the quality of life was measured by using QLQ C-30 questionnaire adapted for chronic pancreatitis patients in Polish population. The patients were assessed prior to the pain-relieving intervention and subsequently 2 and 8 weeks after it. The intensity of pain was reduced in both groups significantly after performing the NCPB. Patients who declared a deep faith reported higher level of pain on the VAS scale prior to intervention than non-religious patients. Quality of life in both groups of patients significantly improved after NCPB. Following NCPB, global quality of life in patients who declared higher religiosity/church attendance was significantly higher (79.88) than for those patients who have no contact or sporadic contact with the church (44.21, P < 0.05). NCPB resulted in significant reduction of pain and increase in quality of life in both groups of patients with CP. Nevertheless, in the group declaring higher religiosity/church attendance, reported pain was higher, but, despite that, quality of life better. It may be concluded that religious practices might serve as an additional factor improving quality of life and coping in patients suffering from chronic pancreatitis.     

Learning from Physical Pain to Help with the Management of Emotional Pain

There may be important similarities between chronic emotional pain and chronic physical pain. Both forms of chronic pain may promote negative beliefs about the self and the future. Chronic emotional pain and chronic physical pain both serve to disrupt patients’ focus from their actions and goals. Techniques used for the treatment of physical pain may be translated into the treatment of emotional pain. Four core strategies are reviewed including: (1) reducing catastrophic interpretations, (2) increasing tolerance by promoting acceptance, (3) cultivating positive expectations, and (4) remaining flexible in movements and attitudes. Patients can learn to tolerate limitations while pursuing their goals. Clinicians can help patients to reduce emotional pain by making a series of small changes in their thoughts and behavior.     

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.     

Hope in a strengths-based group activity for individuals with chronic pain

While hope has been described as the ability to imagine a future in which one wishes to participate, individuals with chronic pain can have difficulty maintaining hope due to the pervasive impact of pain on multiple facets of their lives. This research examines client experiences of hope during a hope and strengths activity offered as part of a group treatment plan for individuals experiencing chronic pain. Entitled Being Hopeful in the Face of Chronic Pain, the group was developed in order to focus on hope and generative emotional experiences, experiences often lacking for individuals with chronic pain. The group activity being studied specifically addressed participants’ current strengths and strengths they hope-to-have-more-of. The study employed basic qualitative inquiry and utilized interpersonal process recall individual interviews to stimulate participant recall. Twelve participants (spanning three separate group offerings) individually discussed their personal experiences as they unfolded during a specific hope and strengths-focused activity. Participants described experiences during the group activity that fostered personal hope via perspective shifts, communion, comparison and connection with other group members. Findings are discussed in the context of current literature on hope, chronic pain, positive psychology and group interventions.