Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Abstract

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factor in the transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whether they arc associated with the inception of an episode of neck or back pain. The aim of this study was to evaluate prospectively the effects of fear-avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported no spinal pain during the past year. At the pretest a battery of questionnaires was administered to assess beliefs about pain and activity and it featured the Pain Catastrophizing Scale and a modified version of the Fear-Avoidance Beliefs Questionnaire. One year later outcome was evaluated by self-reports of the occurrence of a pain episode as well as a self-administered physical function test. The results showed that scores on both fear-avoidme and cabstrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the median on fear-avoidance beliefs at the pretest had twice the risk of suffering an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, increasing the risk of pain or lowered function by 1.5. but with confidence intervals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early pint in the development of pain and associated activity problems in people with back pain. Theoretically. our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastrophizing and particularly fear-avoidance beliefs are important in the development of a pain problem and might be of use in screening procedures.     

Attentional deficits in fibromyalgia and its relationships with pain,emotional distress and sleep dysfunction complaints

Cognitive complaints are common among subjects with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints.     

Temporal dimensions of the self-concept: Entrapped and possible selves in chronic pain

Abstract

The purpose of this qualitative study was to explore temporal aspects of chronic pain patients' conceptions of their selves; what they were in the past, how they were functioning at the present and what they thought about their potential and future. In-depth interviews with 21 chronic pain patients were performed and analysed. The main results of the analysis included four higher-order conceptual patterns: “the body and I”, “maintaining the consistency of past self”, the “entrapped self”, and “projected selves, defined by others”. These results are presented in a systems-oriented model illustrating the temporal dynamic between the perceived functioning self, the body and others, such as health care personnel and significant others. The mechanisms of the process of how selves are developing in the chronisation or healing process of pain are finally discussed. A clinical implication of these findings might be that with an enlarged insight of the temporal dynamic and the importance of interactive and social factors in shaping positive possible selves, health care personnel can contribute more effectively in stew-arding the chronic pain patient toward health-promotive ends and a concomitantly higher quality of life.     

Change in physical self-perceptions across the transition to secondary school: Relationships with perceived teacher-emphasised achievement goals in physical education

ObjectivesThis study aimed to examine the effects of change in perceived teacher achievement goal emphasis in physical education (PE) on physical self-perceptions and self-esteem across the transition to secondary school.Design & methodsA longitudinal design was adopted with three time points, one at the end of primary school and two during the first year of secondary school. Participants (N = 491) were cross-classified by primary (N = 42) and secondary (N = 46) PE class in order to examine the association between perceived class-level teacher-emphasised goals and within-class student goals with self-beliefs.ResultsPersonal approach goals and class perceptions of teacher mastery approach goal promotion were all positively associated with ratings of co-ordination, sport competence, flexibility, and endurance in primary school. More favourable perceptions of coordination, sport competence, strength, flexibility, and endurance during the first year of secondary school were predicted by an increase in performance approach goal emphasis, whereas ratings of sport competence and flexibility were negatively associated with an increase in mastery approach goal emphasis.ConclusionsAlthough not entirely consonant with theoretical predictions, current findings suggest that teacher-emphasised performance approach goals in PE can promote development of several physical self-perceptions in the initial year of secondary school.     

Rethinking ‘Don't Blame the Victim’

SUMMARY

The psychology of victims and the dynamics of victimhood have been largely ignored by scholars and clinicians. While in past years the tendency has been to blame victims, more recently the tide has turned. It is now politically incorrect to explore the role of victims in violent systems, as exploring the psychology of victims has become synonymous with blaming the victim. While shying away from blame, this article will explore the familial and cultural origins of victimhood, victims' characteristics, their relationships with the perpetrators, and it will offer a victim typology. As we move from btame to a more complex understanding of violent systems, the perpetuation of these systems in our culture, and the role victims play in these systems, we provide ourselves with better tools to predict and prevent further victimization.     

The Pain of Dying

SUMMARY

Dying can be a painful and difficult business. Fears, hopes, losses, questions, and uncertainty result in a form of pain that lies beyond the therapeutic reach of science and pharmacology. Efforts to preserve and prolong life or to make things better can sometimes result in this pain being overlooked or remaining unheard. To search the deepest part of oneself is the journey that beckons us all as we are dying. Within this space resides the source of our own suffering but also the seeds for healing. This exploration has a momentum of its own but requires conditions not often found within the biomedical paradigm. If this model of care remains the only source of hope for those with a life-threatening illness, ‘the pain of dying’ may not be addressed.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

Differences in High and Low Anxiety Sensitive Women's Responses to a Laboratory‐Based Cold Pressor Task

Anxiety sensitivity (AS) has been linked to a variety of disabling chronic health conditions, including pain‐related conditions. A recent study has found that healthy women with high AS reported significantly higher levels of sensory and affective pain on an experimental cold pressor task compared to women with low AS. However, this study found no differences between AS groups for pain tolerance or pain threshold. In the present study, which was designed to replicate and extend these findings, 90 undergraduate university women were selected for inclusion in 1 of 2 AS groups (high or low) based on their screening scores on a 16‐item measure of AS. Participants were tested individually on a lab‐based cold pressor task using a variety of self‐report and observer‐measured variables. Data analyses revealed that, as expected, the high AS participants reported significantly more fear in response to the cold pressor on a relevant item of the McGill Pain Questionnaire – Short Form (SF‐MPQ) than did the low AS participants. Also as expected, the high AS participants reported more pain in response to the cold pressor on the Present Pain Index (PPI) of the SF‐MPQ than did the low AS participants. High AS participants did not differ from low AS participants on other aspects of the cold pressor response (e.g. pain threshold, pain tolerance, pain recovery). These results support the role of pain‐related fear as a mediating variable between AS and increased perceived pain intensity.