Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer.

Prior to scheduled surgery, patients frequently experience particularly high levels of distress and expect a variety of postsurgery symptoms. Surgery patients who confront breast cancer are no exception. It has been suggested that such presurgery distress and response expectancies are predictive of postsurgery outcomes. To test the contribution of presurgery distress and expectancies to common postsurgery symptom outcomes (pain, nausea, fatigue, and discomfort), 63 female patients undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery nausea, fatigue, and discomfort; specific expectancies uniquely contributed to pain intensity, pain unpleasantness, and fatigue (ps < .05). Consistent with expectancy theory, associations between response expectancies and postsurgery outcomes were not due to presurgery distress.     

Long-term, non-specific spinal pain: reliable and valid subgroups of patients

The aim of this study was to identify reliable and valid subgroups of spinal pain patients, using data from the Swedish version of the Multidimensional Pain Inventory (MPI-S). A second aim was to test the generalisability of the three patient profiles described in earlier studies on the MPI ("adaptive coper", "dysfunctional" and "interpersonally distressed" patients). The study base consisted of two samples of individuals suffering from long-term, non-specific spinal pain and the results were validated across these samples. Cluster analysis was used to detect distinct groups of patients and the validity of these subgroups was evaluated on variables not used to generate the cluster solution. One subgroup was characterised by lower pain severity, lower interference with everyday activities, lower affective distress and higher life control than the other two subgroups. This patient profile was similar to the MPI adaptive coper patients. A second subgroup resembled the dysfunctional patient profile, thus displaying a worse adjustment to chronic pain than the AC patients. The third patient group reported significantly lower levels of social support from "significant others" than the other subgroups. This patient profile was similar to that of the interpersonally distressed patient group. Taken together, the results support the reliability, validity and generalisability of three subgroups of chronic pain patients derived from the MPI-S.     

Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress

Wegner's Theory of Ironic Processes has been applied to study the effects of cognitive strategies to control pain. Research suggests that suppression contributes to a more distressing pain experience. Recently, the acceptance-based approach has been proposed as an alternative to cognitive control. This study assessed the tolerance time, the distress and the perceived pain intensity in three groups (suppression, acceptance and spontaneous coping groups) when the participants were exposed to a cold pressor procedure. Two hundred and nineteen undergraduates volunteered to participate. The suppression group showed the shortest tolerance time and the acceptance group showed the longest tolerance time. The acceptance group showed pain and distress immersion ratings that were significantly lower than in the other two groups, between which the differences were not significant. In the first recovery period, the suppression group showed pain and distress ratings that were higher than in the other two groups. In the second recovery period, although the acceptance group showed pain and distress ratings that were significantly lower than in the other two groups, the suppression and the spontaneous coping groups did not differ. The presence of a 'rebound' of physical discomfort and the effects of suppression on behavioural avoidance are discussed. These results support the acceptance approach in the management of pain.     

Dental pain related to quality of life and mental health in South Korean adults

High levels of stress, anxiety and depression have been reported in patients with orofacial pain. Dental pain has the potential to reduce quality of life (QOL), and pain relief is important aspect of QOL. The purpose of this study was to assess the relationships of dental pain with QOL and mental health using a nationally representative, population-based study. This study analyzed data from the 2012 Korea National Health and Nutrition Examination Survey (N = 5469). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Health-related QOL (HRQOL) was evaluated using EQ-5D and EQ-VAS, and mental health was evaluated by questionnaires. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Among 5469 adults, 1992 (36.42%) presented self-reported dental pain. Participants with anxiety/depression or pain/discomfort, and participants with stress, melancholy, suicidal thought or depression showed significantly higher prevalence of dental pain. After adjusting for covariates, five aspects of QOL and five aspects of mental health were related with dental pain. The AORs (95% CI) for dental pain were 1.39 (1.06–1.81) for mobility, 1.77 (1.19–2.63) for self-care, 1.38 (1.02–1.85) for usual activities, 1.73 (1.43–2.09) for pain/discomfort and 1.50 (1.13–1.98) for anxiety/depression. For mental health status factors, the AORs (95% CI) for dental pain were 1.29 (1.11–1.51) for stress, 1.37 (1.09–1.74) for melancholy, 1.26 (1.01–1.58) for suicidal thoughts, 1.43 (.93–2.19) for consultation to psychiatrist and 1.53 (1.07–2.19) for depression. This study showed that dental pain has an association with lower HRQOL and worse mental health status in South Korean adults.     

Assisted dying: Why the Argument from Sufficient Palliation fails

Opponents of legalising assisted dying often make the Argument from Sufficient Palliation. On the premise that advances in palliative treatment have made it possible to free terminal patients from pain and distress, the argument concludes that assisted dying is unnecessary. I assert that this argument fails. Firstly, the premise is false because patients respond differently to analgesics and many continue to experience intractable pain even on medication. Secondly, the premise fails to acknowledge the extreme discomfort (for many patients) of the side effects of palliative treatment. Thirdly, the conclusion would only follow from the premise if the overwhelming majority of patients had access to palliative treatment, and this is patently not the case. Finally, the argument completely overlooks the enormous distress experienced by terminal patients, arising from perceived loss of dignity and concerns about being a burden to others.     

The Efficacy of Minimal Contact Interventions for Acute Tinnitus: A Randomised Controlled Study

Acute tinnitus can lead to substantial distress and eventually result in long-lasting impairment. The aim of this study was to compare the efficacy of a cognitive-behavioural intervention (delivered as Internet self-management, bibliotherapy or group training) to the information-only control condition.

Applicants suffered from subjective tinnitus for up to six months, were between 18 and 75 years old and received no other tinnitus-related psychological treatment. A total of 304 participants were randomly assigned to one of the four study arms. Tinnitus distress, depressive symptoms, psychosomatic discomfort and treatment satisfaction were assessed.

At the post-assessment tinnitus distress was significantly lower in the Internet and the group training conditions compared to the control condition. Inter-group effect sizes were moderate to large. At follow-up, all active training conditions showed significantly reduced tinnitus distress compared to the control condition (intention-to-treat analysis). An additional completer analysis showed a significant reduction in tinnitus distress only for the group condition. All effect sizes were moderate. There were no differences regarding psychosomatic discomfort, but depressive symptoms were reduced in the group condition at the post-assessment (intention-to-treat analysis). Treatment satisfaction was significantly higher in the training conditions. The dropout rate was 39%.

The present study shows that distress can be reduced as early as the acute stadium and that minimal-contact interventions are a promising way to do this. In particular, the Internet and group conditions led to a large, immediate decrease in distress, and the participants were highly satisfied with the training.     

Relationships Between Physical Symptoms,Emotional Distress,and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.     

Different Associations of Health Related Quality of Life with Pain,Psychological Distress and Coping Strategies in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disorder

The primary aim of this study was to measure psychological distress, pain severity, health related quality of life (QOL) and pain coping strategies in patients with irritable bowel syndrome (IBS) and ulcerative colitis (UC). A second aim was to determine the influence of somatic and psychological variables on health related QOL. Eighty-eight IBS and 66 UC patients completed the Irritable Bowel Syndrome Quality of Life Questionnaire (IBSQOL), Pain Severity Scale of West Haven Yale Multidimensional Pain Inventory (WHYMPY), Symptom Checklist-90-R (SCL-90-R) and Coping Strategies Questionnaire (CSQ). T-tests and GLM Analysis of Covariance were used for statistical analysis. IBS patients had significantly higher levels of psychological distress, pain severity and maladaptive pain coping strategies (catastrophization), and lower QOL than UC patients. Variance of QOL in IBS was explained for the most part by catastrophization (15%), then by psychological distress (8%), and for the less part by pain severity (5%). In UC, pain severity explained 21%, psychological distress 8%, and catastrophization 3% of the variance of QOL. These results suggest there are differences between IBS and UC patients in the role of physical and psychological factors in QOL and emphasize the importance of cognitive processes in IBS.     

Distraction,Control, and Dental Stress1

This study examined the efficacy of external distraction as a coping strategy. Thirty-eight dental patients were randomly assigned to one of three groups: incidental music during the dental procedure, music coupled with suggestions that music would help reduce stress, or a no-treatment control group. Patients in both music groups reported experiencing less stress (i.e., less pain. less discomfort, more control) than patients in the no-treatment group. Patient ratings made by dentists, blind to condition, provided converging evidence for the therapeutic effect of distraction. Thus, distracting music was found to be effective in reducing stress and increasing perceptions of control. The relative ease and simplicity of implementing external distraction compared to manipulating actual control in a medical setting may make this manipulation attractive to professionals involved with individuals experiencing stress.     

Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses.

This study investigated contextual determinants of psychological distress among 197 spouses of cancer patients. It was hypothesized that higher levels of patient functional impairment would lead to greater patient distress. Patient distress, in turn, would lead to lower spouse marital satisfaction and ultimately to higher spouse distress. Spouses completed measures of distress and marital quality at three time points. Cancer patients rated their functional impairment and psychological distress at the same time points. Results indicated that at all time points, greater patient impairment was associated with higher levels of patient distress, which, in turn, was related to lower marital satisfaction. However, marital quality was related to spouse distress at only 1 time point, but spouse distress was directly associated with patient distress at each time point. Implications for cancer patients and spouses are discussed.     

Psychological Disturbances in Patients With Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a functional gastrointestinal disorder (FGID), which causes pancreatobiliary-type pain, cholestasis, and/or pancreatitis. Only a few studies have assessed the level of psychological distress in this population compared to healthy subjects or patients with other gastrointestinal disorders. In this study, we examined the self-reported level of psychological distress and certain psychiatric symptoms of SOD patients, and we compared them to depressed patients as well as healthy subjects. The results indicate that SOD patients have significantly lower levels of global and specific symptoms compared to depressed patients. When compared to healthy subjects, SOD patients expressed significantly higher levels of irritability–oversensitivity, and there was a trend toward higher levels of somatization.     

A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster.

Although patients with chronic pain are often psychologically distressed, it has been difficult to determine whether this distress is an antecedent of chronic pain or whether it is caused by the experience of living with chronic pain. The aim of this investigation was to develop a method that would allow individuals who are at risk for the development of chronic pain to be studied before their pain has become chronic. Patients with acute herpes zoster were assessed with demographic, medical, pain, and psychosocial measures. Pain was assessed in follow-up interviews at 6 weeks and 3, 5, 8, and 12 months after these initial assessments. There were no significant differences between patients who developed short-term herpes zoster pain and patients who did not develop short-term pain for any of the measures at the initial assessment, except for one measure of pain intensity. Patients who developed chronic herpes zoster pain, however, had significantly greater pain intensity, higher state and trait anxiety, greater depression, lower life satisfaction, and greater disease conviction at the initial assessment than patients who did not develop chronic pain. In discriminant analyses, disease conviction, pain intensity, and state anxiety each made a unique contribution to discriminating patients who did and who did not develop chronic pain. This study demonstrates the feasibility of investigating psychosocial antecedents of the development of chronic pain by prospectively examining the longitudinal course of herpes zoster.     

Infant Distress During Immunization: A Multimethod Assessment

The purpose of this study was to comprehensively describe infant procedural distress and pain across assessment modalities, and to compare similarities and differences across measures. A multimethod assessment of distress was conducted to investigate infants (N = 37) undergoing routine immunizations. Measures of infant distress included Parent report, nurse report, infant heart rate, and an observational measure of infant distress. Parents rated their infant's distress and pain significantly higher than did nurses. Observational and physiological ratings of infant distress were found to vary significantly by phase, and there were no correlations between adult ratings of pain and distress and physiological ratings. Findings suggest that infant procedural distress can be assessed in a number of manners. The discordance between these measures emphasizes the need for multimethod assessment of pediatric procedural distress in both research and clinical settings. Given the differences between parent and nurse ratings, clinicians should be aware that different assessment methods might lead to different conclusions about infant procedural distress.     

Applications cliniques en psychologie de la santé

The aim of the present article is to present recent and validated clinical applications in the field of health psychology, in particular regarding pain and chronic disease management. Techniques such as acceptance and engagement therapy, mindfulness meditation and positive emotions enhancement have proved to be successful. Mindfulness is an attribute of consciousness long believed to promote well-being. It is commonly defined as the state of being attentive to and aware of what is taking place in the present. By this way, mindfulness meditation learns to patients with chronic pain to reduce their pain sensation. Moreover, encourage patients to have positive emotions, such as gratitude, is efficient in long term well-being. Prospective studies reveal that optimism, coping strategies such as positive reframing and acceptance, and social support yield less distress for patients with chronic disease. Similarly, psychosocial interventions that foster optimistic appraisals, build coping strategies, and bolster social support are benefit for patients. Other methods such as Cognitive Behavioral Stress Management (CBSM), enable to significantly enhance quality of life, adaptation to illness and chronic disease patient compliance. This 10-week group CBSM intervention that includes anxiety reduction (relaxation training), cognitive restructuring, and coping skills training is tested among women with breast cancer and HIV patients. The intervention reduces reports of thought intrusion, anxiety and emotional distress. Furthermore, biofeedback through Heart Rate Variability appears to be an important component of the development of patient potential in terms of cognitive and emotional resources enabling better coping with stressful situations and hence maintaining optimal health conditions. Biofeedback treatment intervention on pain and quality of life is helpful in the rehabilitation of patients with chronic pain. Limits of these applications are discussed as well as future research directions.     

Quality of Well-Being Scale and Chronic Low Back Pain

Outcome measures that assess quality of life for use in health policy decisions need to be investigated in chronic pain patients. In the present study, the validity of the Quality of Well-Being Scale (QWB) was evaluated on 67 adult chronic low back pain (CLBP) patients who were enrolled in a 12-week multidisciplinary pain treatment program. Participants completed the QWB, a battery of pain measures, a behavioral observation task, and a medical exam. The findings indicated that CLBP patients have a low level of functioning or quality of life (M = .567, SD = .08) compared with persons with life-threatening diseases. The QWB score was significantly correlated with observational measures of pain behavior and pain-related coping strategies. Multivariate analysis indicated that interference in daily activities, distorted ambulation, affective distress, pain duration, and guarding were the most significant predictors of quality of well-being (multiple R = .84, p < .0001). Patients with medically incongruent physical signs had significantly lower QWB scores than patients with congruent signs. Overall, the data supported the validity of the QWB in a sample of CLBP patients.     

恐惧的代价：疼痛恐惧、心理忧虑和躯体化对疼痛感知预测作用的比较

首次在无痛群体中比较疼痛恐惧、心理忧虑和躯体化对疼痛感知的预测作用大小及调节和中介关系。以多个同类量表得分的Z分数加和作为三者的因子分,以冷压痛觉测验（CPT）疼痛指标（阈限、耐受性、强度、不愉快度）为目标变量,通过分层回归及调节和中介作用分析,发现疼痛恐惧对疼痛不愉快度的预测作用最强,心理忧虑对疼痛体验（强度、不愉快度）的预测作用被疼痛恐惧完全中介,躯体化只有在高疼痛恐惧条件下才显著负向预测疼痛不愉快度。综上,疼痛恐惧是三因素中预测CPT疼痛体验的主要因素。     

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.     

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia

Fibromyalgia (FM ) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self‐awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem‐focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally‐oriented thinking factor of alexithymia significantly explained both problem‐ and emotion‐focused coping, while the difficulty‐describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.     

A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.

OBJECTIVE: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. METHOD: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by an average of 18.5 weeks. RESULTS: Correlation analyses showed that acceptance of pain and values-based action measured at Time 1 were significantly correlated with pain, pain-related distress, pain-related anxiety and avoidance, depression, depression-related interference with functioning, and physical and psychosocial disability measured at Time 2. Multiple regression analyses, in which pain and relevant patient background variables were controlled, showed that the combined acceptance and values measures accounted for between 6.5% and 27.0% of variance in six key measures of patient functioning later in time. CONCLUSION: These results support the importance of acceptance and values-related processes in relation to chronic pain. These results also encourage continued applications of a functional contextual model of psychopathology, the model underlying Acceptance and Commitment Therapy and related approaches such as Contextual Cognitive-Behavioral Therapy.