Does sex moderate the relationship between anxiety and pain?

Objectives : Sex differences exist in the relationship between anxiety and pain, although findings are mixed. One reason could be because a number of anxiety measures have been used. Therefore, this study aimed to identify the core components within commonly used pain anxiety measures, and see whether these components are differentially related to sensation and pain thresholds in men and women.

Design, main outcome measures : One hundred and eighty-nine healthy adults (119 female) completed the Fear of Pain Questionnaire, Pain Catastrophising Scale, Pain Anxiety Symptoms Scale, Anxiety Sensitivity Index-3 and the Depression Anxiety Stress Scale. Thermal sensation and pain thresholds, mechanical sensation and pressure pain thresholds were also collected.

Results : A Principal Components Analysis of anxiety measures revealed three constructs: general distress, cognitive intrusion and fear of pain from injury/insult. Sex did not moderate the relationship between these anxiety constructs and sensation/pain thresholds. However, a significant main effect of sex was found to predict thermal pain thresholds.

Conclusion : Preliminary indications suggest that pain anxiety dimensions can be reduced to three core constructs, and used to examine pain sensation. However, sex did not moderate this relationship. Further research is required to establish the extent and strength of sex differences in the relationship between anxiety and pain.     

The effect of pre-treatment enquiries on child dental patient's post-treatment ratings of pain and anxiety

Abstract

The aim of this study was to attempt to replicate a study in adults: to determine whether pre-treatment enquiries about anxiety and pain in children, attending the dentist, influenced their subsequent reports of pain and anxiety immediately after treatment. One hundred and ninety five children aged from seven to 16, attending four Community Dental Clinics, were allocated at random to five groups. Before treatment the first group was asked questions about their dental anxiety, expectations and memories of pain. The second group was asked about dental anxiety and expectations of pain. The third group was asked only about dental anxiety; the fourth was asked only about pain. The fifth, the control group, was asked about none of these topics. All the children were asked after treatment to rate 1) their anxiety about dentistry and 2) their experience of pain in the treatment just completed. The children experienced less pain than they had expected. There were no differences between the groups in disruptiveness or in the amount of pain experienced. However, the children who were asked about both pain and dental anxiety (groups one and two) reported significantly less dental anxiety than the control group. These results are consistent with the conclusion that pre-treatment enquiries about both anxiety and pain have no effect on disruptiveness or the experience of pain but do reduce anxiety about dentistry.     

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

Abstract

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

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

Abstract

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

A contextual approach on sex-related biases in pain judgements: The moderator effects of evidence of pathology and patients’ distress cues on nurses’ judgements of chronic low-back pain

Although women report feeling more pain than men, their pain is often underdiagnosed and undertreated. By proposing a gender-based theoretical conceptualisation, we argue that such sex-related biases may be enhanced or suppressed by contextual variables pertaining to the clinical situation, the perceiver or the patient. Consequently, we aimed to explore the moderator role of two clinically relevant variables in a chronic low-back pain (CLBP) scenario: diagnostic evidence of pathology (EP) and pain behaviours conveying distress. One-hundred and twenty-six female nurses (M?=?35.33, SD?=?7.64) participated in an experimental between-subjects design, 2 (patient's sex)?×?2 (EP: present vs. absent)?×?2 (pain behaviours: with vs. without distress). Independent variables were operationalised by vignettes depicting a patient with CLBP. Nurses judged the patient's pain on several dimensions: (1) credibility; (2) disability; (3) severity of the clinical situation; (4) psychological attributions and (5) willingness to offer support. Main findings showed that judgements of women's pain were influenced by EP, while judgements of men's pain were not. Moreover, nurses showed biases against men, but only in the presence of EP. The influence of distress cues was less consistent. Theoretical and practical implications are drawn.     

Social support for women with chronic pelvic pain: what is helpful from whom?

Eight women with Chronic Pelvic Pain (CPP) were asked, by means of semi-structured interview, what had been helpful and unhelpful in terms of social support from their partners, families, friends, acquaintances, doctors, nurses and other women with CPP. Firstly, thematic analysis employing a pre-defined social support category system revealed that particular forms of tangible support were preferred from specific support providers but emotional and informational support was appreciated from the whole support network. Secondly, interpretative phenomenological analysis revealed three major additional themes: ‘Pain and Suffering’ described the trauma suffered by these patients and the anger and anxiety surrounding their experience; ‘Ideal Social Support’ revealed a picture of desired support consisting of enduring emotional and practical support which did not undermine individual autonomy; ‘Shortfalls in Social Support’ had subsidiary themes entitled ‘Lack of empathy’ and ‘Lack of engagement’. These themes were described and discussed in relation to each other, extant research and their clinical implications.     

Assessment,Treatment, and Rehabilitation for Interpersonal Violence Victims

Abstract

Psychotherapists who have received minimal training in neuropsychology do not consider cognitive rehabilitation among the treatment options for their clients who have mild traumatic brain injury (mTBI). Historical perspectives on mTBI did not acknowledge brain plasticity and/or rehabilitation, yet rehabilitation might provide a necessary foundation for a client to be able to benefit from traditional feminist psychotherapy. This article provides an overview of two treatment modalities, biofeedback and neuropsychologically-informed feminist psychotherapy, for women with mTBI who sought relief from interstitial cystitis and headaches. Assessment for neuropsychological treatment planning and monitoring is illustrated with employment of the Ackerman-Banks Neuropsychological Rehabilitation Battery. Clinical examples are provided to demonstrate a variety of manifestations of mTBI and responses to treatment.     

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.     

Athletes' inclination to play through pain: a coping perspective

Previous studies have shown how social networks lead athletes to accept pain as a “part of the game,” which generates pressure on athletes to continue competing despite being in pain. Little is known, however, about the potential coping strategies that are related to pain behavior in sport. This study of 205 combat athletes examined whether pain coping strategies, including distraction from pain, praying, reinterpreting pain sensations, ignoring pain, and pain catastrophizing, are related to athletes’ inclination to play through pain. Results revealed that pain catastrophizing led athletes to reduce their physical involvement in their sport activity. Of particular interest was the moderating effect of ignoring pain such that ignoring pain significantly attenuated the negative effect of pain intensity on athletes’ inclination to play through pain. Few studies have tested and supported the contribution of pain coping to the prediction of behavior in real sport situations. By identifying which coping strategies athletes could use to maintain their physical involvement despite being in (sometimes intense) pain, the current study makes an important contribution for tailoring pain management programs for this at-risk population.     

The Impact of Life-Long Illness on Women: A Qualitative Study of Low Socio-Economic Rheumatoid Arthritis (RA) Patients

The purpose of this qualitative, ethnographic study was to explore the impact of a chronic disease on low socio-economic women with RA in South Africa. Ten women participants with a mean age of 48 years and a mean duration of RA of 10 years were obtained through purposive sampling from a public hospital RA clinic. In-depth individual interviews were conducted as a method of data collection. The interviews were tape recorded and transcribed for the data analysis. Grounded theory analysis was used which produced 3 primary categories around the impact of RA: (1) Physical impact, (2) Social and economic impact, and (3) Psychological impact; and 5 sub-categories, namely, Pain and poor Functional Status, Change in life-style following a weakened economic position, Change in the constitution of the “Self”, Change in the constitution of the “Self” of the spouse/partner, and Depression. Depression, pain and poor functional status are well known health outcomes for RA patients. Perceived change in the psychological concept of the “Self” is less frequently reported. The value of this study is that the concept of the self is further explored in chronically ill individuals as a ‘fluid’ one, with the potential for undergoing a complete transformation as a consequence of RA.