Attention Modification in Persons with Fibromyalgia: A Double Blind,Randomized Clinical Trial

Contemporary models of chronic musculoskeletal pain emphasize the critical roles of fear, anxiety, and avoidance as well as biases in attention in the development and maintenance of chronic pain disability. Evidence supports the influence of individual difference variables such as anxiety sensitivity, pain-related anxiety, and catastrophizing on the pain experience and on pain-related attentional biases. Changes in attentional biases have been associated with treatment gains in patients with clinically significant anxiety. The Attentional Modification Paradigm (AMP) is a modification of the dot-probe paradigm used to facilitate such changes in attentional biases. Given the relationship between chronic musculoskeletal pain and anxiety, AMP may be effective in reducing pain as well. Participants included persons (n = 17) with fibromyalgia and were randomly assigned to either an AMP condition or a control condition. The participants completed two 15-minute AMP sessions per week for 4 weeks. Those in the AMP condition reported statistically significant and substantial reductions on several individual difference variables relative to those in the control condition, and a greater proportion experienced clinically significant reductions in pain. These preliminary results offer a promising new avenue for treating chronic musculoskeletal pain that warrants additional research. Comprehensive results, limitations, and future directions are discussed.     

Relationships among pain intensity,pain-related distress,and psychological distress in pre-surgical total knee arthroplasty patients: a secondary analysis

The current study aimed to examine the relationships between movement and resting pain intensity, pain-related distress, and psychological distress in participants scheduled for total knee arthroplasty (TKA). This study examined the impact of anxiety, depression, and pain catastrophizing on the relationship between pain intensity and pain-related distress. Data analyzed for the current study (N = 346) were collected at baseline as part of a larger Randomized Controlled Trial investigating the efficacy of TENS for TKA (TANK Study). Participants provided demographic information, pain intensity and pain-related distress, and completed validated measures of depression, anxiety, and pain catastrophizing. Only 58% of the sample reported resting pain >0 while 92% of the sample reported movement pain >0. Both movement and resting pain intensity correlated significantly with distress (r_s = .86, p < .01 and .79, p < .01, respectively). About three quarters to two thirds of the sample (78% for resting pain and 65% for movement pain) reported different pain intensity and pain-related distress. Both pain intensity and pain-related distress demonstrated significant relationships with anxiety, depression, and catastrophizing. Of participants reporting pain, those reporting higher anxiety reported higher levels of distress compared to pain intensity. These findings suggest that anxious patients may be particularly distressed by movement pain preceding TKA. Future research is needed to investigate the utility of brief psychological interventions for pre-surgical TKA patients.     

Synergistic effects of pain and alcohol use in relation to depressive and anxiety symptoms among Latinos in primary care

Although past work has shown that alcohol use co-occurs with anxiety/depression among Latinos, little work has examined the variables that qualify such associations. The present investigation sought to address whether pain severity (i.e. pain intensity and/or pain-related disability, respectively) moderated relations between hazardous drinking and depressive/anxious arousal symptoms among an economically disadvantaged Latino sample recruited from a primary care medical setting. Participants included 253 adult Latinos (M_age = 38.5 years, SD = 10.8; 86.6% female) who attended a community-based primary care clinic. There was a significant interaction of hazardous drinking with pain intensity in relation to depressive symptoms and significant interactions of hazardous drinking and pain-related disability in relation to depressive and anxious arousal symptoms. Hazardous drinking was associated with more severe depressive/anxious arousal symptoms only when pain intensity/disability was high. This is the first study to demonstrate the moderating role of pain intensity and disability in associations between hazardous drinking and anxiety/depression among Latinos in a primary care medical setting.     

Everyday worry in adolescents with and without chronic pain: a diary study

Young people report frequent worry, but we know little about the extent, character, or consequence of worry in adolescence, or individual differences associated with worry. Adolescents with chronic pain are one population that are known to have high levels of anxiety, which is associated with higher levels of disability and depression, impairing function. In this study we report a diary study: adolescents (N = 60; aged 16–18) recorded their worry over seven days. Our first aim was to describe the characteristics of adolescent worry and its consequences in a community sample. Our second aim was to compare the experience of girls to boys, and to compare the experience of those with and without chronic pain. Adolescents reported characteristics of each worry they had throughout the week, including content, frequency, strength, interference, emotion, and the strength of emotion associated with worry content. Adolescents reported the consequence for each content and the strength of the consequence. Worry content and consequences were categorised into four categories; health, relationship, personal competence, and other. Adolescents reported 675 unique episodes of worry over the seven-day period that were predominantly about personal competence. The strength of worry content was (M = 6.61, SD = 1.27) and the strength associated with the worry consequence was (M = 5.59, SD = 1.41). Worries were not reported as highly interfering (M = 4.14, SD = 1.61). Contrary to predictions, there were no differences in worry characteristics between adolescents with and without chronic pain. To conclude, worry is a frequent occurrence in older adolescents and the characteristics of worry are discussed. Adolescents worry mostly about personal competence. Adolescents with and without chronic pain reported similar worry characteristics.     

Pain-Related Anxiety and Marijuana Use Motives: A Pilot Test Among Active Marijuana-Using Young Adults

The present investigation examined pain-related anxiety in regard to marijuana use motives among a sample of young adult marijuana users (N = 180; 45% women; M _age = 21.11 years, SD = 6.41). Hierarchical multiple regression analyses were used to determine the relations between pain-related anxiety and marijuana use motives. After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, current rate of alcohol consumption, level of bodily pain (current), and other marijuana use motives, pain-related anxiety was significantly and uniquely associated with coping and conformity motives for marijuana use. Pain-related anxiety was not significantly related to other marijuana use motives. These results offer novel empirical insight pertaining to a relation between pain-related anxiety and coping as well as conformity motives for marijuana use among active users.     

The Nature of the Association between Anxiety Sensitivity and Pain-Related Anxiety: Evidence from Correlational and Intervention Studies

High anxiety sensitivity (AS) has been associated with elevated pain-related anxiety in anxiety and pain samples. The present study investigated (a) the associations among the lower order dimensions of AS and pain-related anxiety, using a robust measure of AS, and (b) the pain-related anxiety outcomes of a telephone-delivered cognitive behavioural treatment (CBT) designed to reduce high AS. Participants were 80 anxiety treatment-seeking participants with high AS (M age = 36 years; 79% women). After providing baseline data on AS and pain-related anxiety, participants were randomly assigned to an eight-week telephone CBT or a waiting list control. At baseline, bivariate correlations showed AS physical and cognitive, but not social, concerns were significantly associated with pain-related fear and arousal but not escape/avoidance behaviours. Multiple regression revealed that after accounting for emotional distress symptoms, AS physical, but not cognitive or social, concerns uniquely predicted pain-related anxiety. Multilevel modelling showed that the AS-targeted CBT reduced pain-related anxiety and treatment-related changes in global AS and AS physical concerns mediated changes in pain-related anxiety. Results suggest that an AS-targeted intervention may have implications for reducing pain-related anxiety. Further research is needed in a chronic pain sample.     

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.     

The role of athletes' pain-related anxiety in pain-related attentional processes

Numerous researchers have highlighted the social determinants of athletes' attitude toward pain, yet little is known about the role of cognitive processes and emotions that are related to pain in sport endeavors. There is evidence, in a dot probe paradigm, that individuals with chronic pain selectively orient their attention toward pain-related stimuli, but no studies have differentiated between the two attentional processes of hypervigilance that are evident in athletes: facilitated detection of threat and difficulty in disengaging attention from threatening stimuli. In the present study using a dot probe paradigm, we examined whether professional rugby players (N=58) with high pain-related anxiety (HPA) would show an attentional bias for pain-related threat, and whether this hypervigilance would reflect difficulty disengaging from threat or facilitated detection of threat. Rugby players with HPA oriented their attention toward pain-related threat with a concomitant difficulty disengaging from threat. Difficulty disengaging from painful stimuli may increase anxiety, and thus be maladaptive in sport. This is the first study to identify pain-related anxiety as a vulnerability marker in athletes' attentional biases.     

Prediction of experimental pain sensitivity by attention to pain-related stimuli in healthy individuals

The aim of the present study was to assess the predictive power of the processing of pain-related information, comprising concepts of hypervigilance to pain, pain catastrophizing, and pain-related anxiety (questionnaires) as well as attentional processes related to pain-related stimuli (dot-probe task) in explaining individual differences in experimental pain sensitivity (pressure/thermal pain threshold). In 160 healthy participants (ages 13-61; 80 females), results of hierarchical multiple regression analyses showed that self-reported hypervigilance contributed significantly to the prediction of pain sensitivity, whereas pain catastrophizing and anxiety did not. However, inconsistent with prediction, the effect was in the opposite direction, indicating that vigilance to pain sensations or stimuli is associated with lower pain sensitivity in healthy individuals. Entering the attentional bias indices from the dot-probe task showed that an increased bias to pain words is related to higher experimental pain sensitivity, which confirms the hypothesis.     

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

Subjective Well-Being in Adolescence: The Role of Self-Control,Social Support,Age, Gender,and Familial Crisis

Focusing on adolescents’ subjective well-being, the present study comprised three parts. The first examined the role of two coping mechanisms, self-control and social support, in predicting subjective well-being. The second related to the role of age and gender in predicting adolescents’ subjective well-being. The third raised the question of whether exposure to familial crisis would predict adolescents’ subjective well-being and whether self-control and social support would moderate the link between crisis and adolescents’ subjective well-being. Participants included 380 adolescents ages 13–17 years (M = 15.32, SD = .98; 194 boys, 176 girls, 10 unspecified), from six integrative junior-high and high schools in central Israel. All schools served a heterogeneous Jewish student population. Based on responses to a questionnaire identifying adolescents who reported experiencing a severe life crisis during the last year (e.g., severe illness in family, parent death or separation/divorce), the sample was divided into two groups: exposure to familial crisis (n = 96) and no exposure to familial crisis (n = 284). Outcomes revealed that both self-control and social support predicted adolescents’ subjective well-being. As expected, older adolescents presented lower levels of subjective well-being than younger ones. In contrast to the hypothesis, gender did not predict subjective well-being. Although exposure to crisis did not predict higher negative affect or lower positive affect, an interaction emerged between self-control and crisis in predicting positive affect. Thus, among adolescents who experienced crisis, better self-control skills predicted higher levels of positive affect.     

Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain

The aim of this investigation was to examine the effectiveness of a graded exposure in vivo treatment with behavioural experiments as compared to usual graded activity in reducing pain-related fears, catastrophising and pain disability in chronic low back pain patients reporting substantial fear of movement/(re)injury. Included in the study were four consecutive CLBP patients who were referred for outpatient behavioural rehabilitation, and who reported substantial fear of movement/(re)injury (Tampa Scale for Kinesiophobia score>40). A replicated single-case cross-over design was used. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In intervention A, patients received the exposure first, followed by graded activity. In intervention B, the sequence of treatment modules was reversed. Sixty-three daily measures of pain-related cognitions and fears were recorded with visual analogue scales. Before and after the treatment, the following measures were taken: pain-related fear, pain catastrophising, pain control and pain disability. Using time series analysis on the daily measures of pain-related cognitions and fears, we found that improvements only occurred during the graded exposure in vivo, and not during the graded activity, irrespective of the treatment order. Analysis of the pre-post treatment differences also revealed that decreases in pain-related fear concurred with decreases in pain catastrophising and pain disability, and in half of the cases an increase in pain control. This study shows that the external validity of exposure in vivo also extends to the subgroup of chronic low back pain patients who report substantial fear of movement/(re)injury.     

Attention modification in persons with fibromyalgia: a double blind, randomized clinical trial

Contemporary models of chronic musculoskeletal pain emphasize the critical roles of fear, anxiety, and avoidance as well as biases in attention in the development and maintenance of chronic pain disability. Evidence supports the influence of individual difference variables such as anxiety sensitivity, pain-related anxiety, and catastrophizing on the pain experience and on pain-related attentional biases. Changes in attentional biases have been associated with treatment gains in patients with clinically significant anxiety. The Attentional Modification Paradigm (AMP) is a modification of the dot-probe paradigm used to facilitate such changes in attentional biases. Given the relationship between chronic musculoskeletal pain and anxiety, AMP may be effective in reducing pain as well. Participants included persons (n = 17) with fibromyalgia and were randomly assigned to either an AMP condition or a control condition. The participants completed two 15-minute AMP sessions per week for 4 weeks. Those in the AMP condition reported statistically significant and substantial reductions on several individual difference variables relative to those in the control condition, and a greater proportion experienced clinically significant reductions in pain. These preliminary results offer a promising new avenue for treating chronic musculoskeletal pain that warrants additional research. Comprehensive results, limitations, and future directions are discussed.     

Influence of obstetrical events on satisfaction and anxiety during childbirth: a prospective longitudinal study

The aim of this study was to investigate the feelings of anxiety and satisfaction among 79 primiparas who had uncomplicated pregnancies, at the time of hospital admission and after birth, considering the mode of delivery, analgesia, and pain levels. Questionnaires were completed at admission to the hospital and two months after delivery, using the State-Trait Anxiety Inventory (STAI) state scale and the Labour Agentry Scale. The mean (SD) STAI state score was higher at admission (36.7 (10.7)) than 4 months after childbirth (32.1 (9.7)) (paired Student’s t-test, t = 2.93; df = 78; p = .004). However, the postnatal anxiety was not associated with the mode of delivery, epidural or pain. Regarding the satisfaction with the expectations of control during childbirth, the mean (SD) score was higher before childbirth (166.0 (21.8)) than after (157.5 (33.5)) (paired Student’s t-test, t = ?2.28; df = 77; p = .03). The satisfaction with the childbirth experience was significantly associated with the expectations of childbirth and the mode of delivery, but not with analgesia or pain. The postnatal anxiety was associated with physical health, pain and the Edinburgh Postnatal Depression Scale score during the postpartum period. It is important to consider the temporality of perinatal anxiety in order to understand its causes. Our results indicate that the experience of childbirth was predicted in this sample by the antenatal expectations and delivery outcomes.     

Stress,coping, executive function,and brain activation in adolescent offspring of depressed and nondepressed mothers

This study examined the associations among chronic stress, activation in the prefrontal cortex (PFC), executive function, and coping with stress in at-risk and a comparison sample of adolescents. Adolescents (N = 16; age 12–15) of mothers with (n = 8) and without (n = 8) a history of depression completed questionnaires, neurocognitive testing, and functional neuroimaging in response to a working memory task (N-back). Children of depressed mothers demonstrated less activation in the anterior PFC (APFC) and both greater and less activation than controls in distinct areas within the dorsal anterior cingulate cortex (dACC) in response to the N-back task. Across both groups, activation of the dorsolateral PFC (DLPFC; Brodmann area [BA9]) and APFC (BA10) was positively correlated with greater exposure to stress and negatively correlated with secondary control coping. Similarly, activation of the dACC (BA32) was negatively correlated with secondary control coping. Regression analyses revealed that DLPFC, dACC, and APFC activation were significant predictors of adolescents’ reports of their use of secondary control coping and accounted for the effects of stress exposure on adolescents’ coping. This study provides evidence that chronic stress may impact coping through its effects on the brain regions responsible for executive functions foundational to adaptive coping skills.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.     

Self-conscious emotions in patients suffering from chronic musculoskeletal pain: A brief report

Objective: The role of self-conscious emotions (SCEs) including shame, guilt, humiliation and embarrassment are of increasing interest within health. Yet, little is known about SCEs in the experience of chronic pain. This study explored prevalence and experience of SCEs in chronic pain patients compared to controls and assessed the relationship between SCEs and disability in pain patients.

Design and measures: Questionnaire assessment comparing musculoskeletal pain patients (n = 64) and pain-free control participants (n = 63). Pain was assessed using the McGill Pain Questionnaire; disability, using the Roland–Morris Disability Questionnaire; and six SCEs derived from three measures (i) Test of Self-Conscious Affect-3 yielding subscales of shame, guilt, externalisation and detachment (ii) The Brief Fear of Negative Evaluation Scale and (iii) The Pain Self-Perception Scale assessing mental defeat.

Results: Significantly greater levels of shame, guilt, fear of negative evaluation and mental defeat were observed in chronic pain patients compared to controls. In the pain group, SCE variables significantly predicted affective pain intensity; only mental defeat was significantly related to disability.

Conclusion: Findings highlight the prevalence of negative SCEs and their importance in assessment and management of chronic pain. The role of mood in this relationship is yet to be explored.     

The relationship between family support; pain and depression in elderly with arthritis

The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.     

Associations of depression,anxiety and PTSD with neurological disability and cognitive impairment in survivors of moyamoya disease

Depression, anxiety and posttraumatic stress disorder (PTSD) are common complications of cerebrovascular diseases. However, they were seldom explored in Moyamoya Disease (MMD) survivors. In this study, we measured the prevalence of depression, anxiety and PTSD in MMD survivors. We evaluated the association of mental disorders with neurological disability and cognitive impairment, and further find out the independent protective and risk factors of neurological disability and cognitive impairment. In MMD survivors, the prevalence of these three mental disorders is high, 46.7% for depression, 50% for anxiety and 47.5% for PTSD. Anxiety and PTSD were significantly associated with more severe neurological disability (p = 0.039 and < 0.001); depression and anxiety were significantly associated with greater cognitive deficiency (p = 0.004 and 0.002). We further found PTSD was the only risk factor associated with neurological disability, and the corresponding odds ratio (OR) and 95% confidence interval (CI) was 81.74 (9.91–674.17); depression and anxiety were risk factors associated with cognitive impairment, and the corresponding OR and 95%CI were 2.73 (1.10–6.81) and 3.37 (1.29–8.78). Therefore, these three mental disorders were associated with more severe neurological disability and greater cognitive deficiency in MMD survivors.